title: Elective neck dissection during salvage surgery for locally recurrent head and neck squamous cell carcinoma after radiotherapy with elective nodal irradiation.
abstract: OBJECTIVE
  To define the role of elective neck dissection during salvage surgery for locally recurrent head and neck squamous cell carcinoma (SCCA) initially treated with elective nodal irradiation (ENI).
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  We reviewed the medical records of patients treated with ENI at our institution from 1965 to 2006 for T1-4 N0 M0 SCCA of the oropharynx, hypopharynx, or larynx who developed an isolated local recurrence and remained N0. Fifty-seven patients were salvaged, 40 with neck dissection and 17 with neck observation. We then compared toxicity and actuarial outcomes between the two groups. Results were compared to the pertinent literature in a pooled analysis.
  
  
  RESULTS
  Four of 46 (9%) heminecks were found to have occult metastases in dissected specimens. The 5-year local-regional control rate was 75% for all patients. Neck dissection resulted in poorer outcomes compared with observation. In the dissected group, the 5-year local control, regional control, cause-specific survival, and overall survival rates were 71%, 87%, 60%, and 45%, respectively, compared to 82%, 94%, 92%, and 56%, respectively, for the observed group. Toxicity was more likely with dissection. In the pooled analysis totaling 230 patients, the overall pathologic positive rate of neck-dissection specimens was 9.6%; the compiled data showed no improvement in outcomes when salvage included neck dissection.
  
  
  CONCLUSIONS
  Routine elective neck dissection should not be included during salvage surgery for locally recurrent head and neck SCCA if initial radiotherapy includes ENI. The risk of occult neck disease is low, outcomes do not improve, and the likelihood of toxicity increases. Laryngoscope, 2010.
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA.
authors.forename: Roi
authors.initials: R
authors.lastname: Dagan
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Kirwan
authors.forename: John W
authors.initials: JW
authors.lastname: Werning
authors.forename: Mikhail
authors.initials: M
authors.lastname: Vaysberg
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Amdur
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002423:Cause of Death; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D015182:Lymphatic Irradiation; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D009367:Neoplasm Staging; D010039:Otorhinolaryngologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D016879:Salvage Therapy / Q000379:methods*