title: Patterns of failure among patients with squamous cell carcinoma of the head and neck who obtain a complete response to chemoradiotherapy.
abstract: BACKGROUND
  The role of adjuvant neck dissection in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) who obtain complete clinical and radiologic response following definitive chemoradiation treatment is controversial.
  
  
  METHODS
  Patterns of failure among 120 patients with locally advanced SCCHN, all with node-positive disease, treated with concurrent chemoradiation, were analyzed.
  
  
  RESULTS
  Ninety-one of the patients achieved a complete response and were observed without undergoing neck dissection. Isolated failure in the neck occurred in 2 patients. The most common site of failure was metastatic disease (17 patients). Six patients had recurrence at the primary only, and 1 experienced failure in the neck and at the primary. Partial responders with resectable disease underwent neck dissection following chemoradiation. This group had worse local control and overall survival compared with complete responders.
  
  
  CONCLUSIONS
  We recommend observation after definitive chemoradiation for complete responders. Further research is needed to improve outcomes among partial responders.
authors.affiliation: Department of Radiation Oncology, Marlene and Stewart Greenebaum Cancer Center, University of Maryland Medical System, Baltimore, Maryland 21201, USA.
authors.forename: Susannah
authors.initials: S
authors.lastname: Yovino
authors.forename: Kathleen
authors.initials: K
authors.lastname: Settle
authors.forename: Rodney
authors.initials: R
authors.lastname: Taylor
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wolf
authors.forename: Young
authors.initials: Y
authors.lastname: Kwok
authors.forename: Kevin
authors.initials: K
authors.lastname: Cullen
authors.forename: Robert
authors.initials: R
authors.lastname: Ord
authors.forename: Ann
authors.initials: A
authors.lastname: Zimrin
authors.forename: Scott
authors.initials: S
authors.lastname: Strome
authors.forename: Mohan
authors.initials: M
authors.lastname: Suntharalingam
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome