Neck response to chemoradiotherapy: complete radiographic response correlates with pathologic complete response in locoregionally advanced head and neck cancer.
OBJECTIVE
The role of neck dissection following chemoradiotherapy (CRT) for locoregionally advanced head and neck cancer is an area of active debate. Patients who have a complete radiographic response may not need dissection, and the extent of neck dissection necessary for those patients with residual disease is unclear.


METHODS
Retrospective review of data from a prospectively collected database of patients with locoregionally advanced head and neck cancer treated as part of a phase 2 study of induction chemotherapy followed by concurrent CRT. The results of post-CRT neck computed tomography (CT) imaging and pathologic analysis of the neck dissection specimens were compared to evaluate correlation between radiographic and pathologic response.


RESULTS
Forty-nine patients underwent 61 hemineck dissections. Overall, 209 neck levels were dissected. Radiologic complete response in the neck was achieved in 39 patients, all of whom had pathologic specimens negative for tumor cells. Ten patients (20%) had a total of 14 neck levels with residual disease on CT imaging. Five (50%) of these 10 patients were found to have residual tumor cells on pathologic analysis. Tumor cells were contained only to those levels found positive on CT imaging; they were present in 7 (50%) of the 14 positive levels.


CONCLUSIONS
Neck levels with residual disease on post-CRT CT imaging warrant removal. However, neck levels without evidence of disease on post-CRT CT imaging are unlikely to harbor cancer, which lends further support to the concept of basing neck dissection on post-CRT staging and performance of limited neck dissections for patients with limited residual disease.
Langerman
Alexander
A
Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL 60637, USA.
Plein
Colleen
C
Vokes
Everett E
EE
Salama
Joseph K
JK
Haraf
Daniel J
DJ
Blair
Elizabeth A
EA
Stenson
Kerstin M
KM
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001706:Biopsy; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D037981:Neck Dissection / Q000379:methods; D009367:Neoplasm Staging / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
D000970:Antineoplastic Agents