Neck dissection after radiochemotherapy in patients with locoregionally advanced head and neck cancer.
BACKGROUND
Primary chemoradiation is a frequent treatment for locoregionally advanced head and neck squamous cell carcinoma. Some authors claim that a neck dissection (ND) is necessary in N2/N3 disease after this treatment in order to avoid regional recurrences. The aim of this study was to determine the incidence of isolated nodal failure in patients with N2/N3 disease who achieved a complete clinical and radiological response (CR) after chemoradiation, when no planned ND was performed.


METHODS
We retrospectively analysed the survival rates, nodal response and subsequent neck nodal control of 28 patients with locally advanced oropharynx, hypopharynx or larynx squamous cell carcinoma disease, treated with primary chemoradiation.


RESULTS
With a median follow-up of 28 months, 2-year global survival was 73% and disease-free survival 60%. Patients who had complete local and regional response after chemoradiotherapy were followed, with 100% neck nodal control.


CONCLUSIONS
Patients with N2/N3 disease who obtained a clinical and radiological CR to chemoradiation had a zero incidence of isolated neck failure without a planned ND. The continued use of planned NDs in this patient subset may not be justified. This can be further confirmed in randomised prospective trials.
López Rodríguez
Mario
M
Servicio de Oncología Radioterápica, Hospital Universitario de la Princesa, Madrid, Spain. mlopezrgez@yahoo.es
Cerezo Padellano
Laura
L
Martín Martín
Margarita
M
Couñago Lorenzo
Felipe
F
D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D017211:Treatment Failure