N2 disease in patients with head and neck squamous cell cancer treated with chemoradiotherapy: is there a role for posttreatment neck dissection?
OBJECTIVE
To determine whether nodal necrosis and node size of 3 cm or larger are risk factors for recurrent neck disease and whether negative computed tomography-positron emission tomography (CT-PET) results 8 weeks or more after therapy indicate complete response in the neck in patients with N2 disease.


METHODS
Retrospective study.


METHODS
State university hospital.


METHODS
Fifty-six patients with head and neck squamous cell cancer and N2 disease treated with chemoradiotherapy were evaluated for persistent or recurrent neck disease. Tumor characteristics analyzed were primary site, T category, nodal size (<3 cm or > or =3 cm), nodal necrosis based on hypodensity of one-third or more of the node, and type of N2 disease (N2a, N2b, or N2c). Forty-eight of the 56 patients underwent CT-PET to determine treatment response after chemoradiotherapy. Clinical examination, imaging, and pathologic specimens were used to confirm disease recurrence.


METHODS
The number of recurrence events, disease-free interval, and positive posttreatment CT-PET result in the neck.


RESULTS
Most patients had oropharyngeal tumors (n = 37; 66%), T2 tumors (n = 21; 38%), nodes 3 cm or larger (n = 43; 77%), positive necrosis (n = 40; 71%), and N2c disease (n = 28; 50%). Multivariate analysis determined that no factors were significant predictors of recurrence, except for positive posttreatment PET results (P < .001). Comparison of CT-PET with nodal recurrence demonstrated a sensitivity of 82%, a specificity of 97%, a negative predictive value of 95%, and a positive predictive value of 90%.


CONCLUSIONS
Posttreatment neck dissections may not be indicated for patients with N2 disease and a negative CT-PET result, even in patients with nodal necrosis and nodes 3 cm or larger.
Cho
Allis H
AH
Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA 71130-3932, USA.
Shah
Shivang
S
Ampil
Fred
F
Bhartur
Sheela
S
Nathan
Cherie-Ann O
CO
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
D000970:Antineoplastic Agents