title: Selective versus comprehensive neck dissection after chemoradiation for advanced oropharyngeal squamous cell carcinoma.
abstract: OBJECTIVE
  To determine whether a comprehensive neck dissection (CND) or a selective neck dissection (SND) is indicated as planned post-primary chemoradiation treatment (CRT) for patients with advanced oropharyngeal squamous cell carcinoma (OPSCC).
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  A community teaching hospital.
  
  
  METHODS
  Patients with advanced OPSCC who received a uniform CRT protocol at Greater Baltimore Medical Center (GBMC).
  
  
  METHODS
  Medical records of patients treated with primary CRT for locoregionally advanced OPSCC at GBMC between 2001 and 2007 were reviewed. All patients received 7000 to 7500, 6000, and 5000 cGy to primary disease sites, involved cervical lymphatics, and uninvolved cervical and supraclavicular lymphatics, respectively, with concomitant cisplatin (12 mg/m(2)/1 h) and 5-fluorouracil (600 mg/m(2)/20 h) given on days one through five and 29 through 33.
  
  
  RESULTS
  Seventy-six patients received CRT, and 41 met the criteria for neck dissection. Forty-eight neck dissections were performed (34 unilateral and 7 bilateral), of which 23 (48%) were CNDs and 25 (52%) were SNDs. Residual carcinoma was found in six (26%) of the CND and five (20%) of the SND heminecks. The CND group had six (26%) complications, whereas the SND group had two (8%).
  
  
  CONCLUSIONS
  The high rate of residual disease demonstrated in this study supports the need for post-CRT neck dissection. Although complication rates were not significantly different between the two groups, the trend in this study indicates that SND results in less morbidity. The presumed reduced morbidity and equivalent regional control rate suggest that SND is an appropriate surgical option for OPSCC patients after primary CRT.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, and the Johns Hopkins Head and Neck Surgery, Baltimore, MD 21231, USA.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Hillel
authors.forename: Carole
authors.initials: C
authors.lastname: Fakhry
authors.forename: Sara I
authors.initials: SI
authors.lastname: Pai
authors.forename: Mark F
authors.initials: MF
authors.lastname: Williams
authors.forename: Ray G F
authors.initials: RG
authors.lastname: Blanco
authors.forename: Eva S
authors.initials: ES
authors.lastname: Zinreich
authors.forename: Marshall A
authors.initials: MA
authors.lastname: Levine
authors.forename: William H
authors.initials: WH
authors.lastname: Westra
authors.forename: John R
authors.initials: JR
authors.lastname: Saunders
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Ha
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016009:Chi-Square Distribution; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011183:Postoperative Complications; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin; D005472:Fluorouracil