title: Treatment outcome in the residually positive neck after definitive chemotherapy and irradiation.
abstract: OBJECTIVE
  Determine prevalence of viable malignancy in patients undergoing neck dissection (ND) for residual neck disease following concomitant chemotherapy and irradiation (chemo/xrt) for upper aerodigestive squamous carcinoma. To determine survival in groups with a neck complete response to those who had residual disease requiring neck dissection.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Retrospective chart review of 230 patients who underwent definitive chemo/xrt for primary squamous cell carcinoma cancer (SCCa) of the head and neck from 2005 to 2009 in one institution.
  
  
  RESULTS
  Thirty-nine (17%) patients underwent ND for residual neck mass within 4 months posttreatment. Forty-nine percent (19/39) were pathologically positive for malignancy and 51% (20/39) were negative. The probability of a +ND based on original N-stage was not statistically significant (P = .368). Primary site did not yield significant probability of having +ND, except in the oral cavity (P = .02). Patients had similar overall 5-year survival, among those with a delayed complete response in the neck (66%), ND for residual disease (71%), or those with initial complete response (71%). Lower initial N-stage demonstrated improved survival in all outcome groups. Tonsil SCCa patients who underwent ND had improved survival compared to those with delayed complete response (87.5 vs. 75.8%), both of which had increased survival compared to initial complete responders (65%).
  
  
  CONCLUSIONS
  This study supports the use of ND in the postchemo/xrt positive neck regardless of primary site or initial N-stage. ND in this setting conveys survival equal to patients with complete response in the neck after chemo/xrt. These survivorship implications of postchemo/xrt neck dissection extend to all sites, including tonsils.
authors.affiliation: University of Louisville Otolaryngology and James Graham Brown Cancer Center, Louisville, Kentucky 40202-1671, USA. lmdool02@gwise.louisville.edu
authors.forename: Laura M
authors.initials: LM
authors.lastname: Dooley
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Potts
authors.forename: Liz D
authors.initials: LD
authors.lastname: Wilson
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Cappello
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Bumpous
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D037981:Neck Dissection; D018365:Neoplasm, Residual; D016019:Survival Analysis; D015996:Survival Rate