title: Extent of neck dissection required after concurrent chemoradiation for stage IV head and neck squamous cell carcinoma.
abstract: BACKGROUND
  The management of initially bulky nodal disease after primary nonsurgical treatment for stage IV head and neck squamous cell carcinoma (HNSCC) continues to be a subject of debate.
  
  
  METHODS
  A retrospective chart review of neck management in patients after chemoradiation was performed.
  
  
  RESULTS
  Of the initially positive necks analyzed, 210/329 (65%) had a complete clinical response to treatment and 161 necks underwent neck surgery. Patients were pathologically positive 13.8% and 39.6% of the time after clinical complete or partial response, respectively. Regional recurrence was more frequent in necks with partial clinical (p = .04) or pathologic responses (p < .01) and with primary site recurrences (p < .01).
  
  
  CONCLUSIONS
  It is still safest at our institution to perform selective neck dissection on patients with > or = N2 neck disease when initially observed to prevent unsalvageable regional recurrence until more accurate interval assessment tools are confirmed.
authors: Department of Otolaryngology, Oregon Health Sciences University, Portland, Oregon, USA. stevencannady@hotmail.com
authors: Steven B
authors: SB
authors: Cannady
authors: Walter T
authors: WT
authors: Lee
authors: Joseph
authors: J
authors: Scharpf
authors: Robert R
authors: RR
authors: Lorenz
authors: Benjamin G
authors: BG
authors: Wood
authors: Marshall
authors: M
authors: Strome
authors: Pierre
authors: P
authors: Lavertu
authors: Ramon M
authors: RM
authors: Esclamado
authors: Jerrold P
authors: JP
authors: Saxton
authors: David J
authors: DJ
authors: Adelstein
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult