title: Elective neck dissection for second primary after previous definitive radiotherapy.
abstract: OBJECTIVE
  The aim of this study was to define the role of neck dissection during surgery for patients who have received elective nodal irradiation in the course of treatment for a prior squamous cell carcinoma of the head and neck (SCCHN) and are subsequently diagnosed with a second primary SCCHN.
  
  
  METHODS
  We reviewed the medical records of 13 patients who received both definitive radiotherapy and elective nodal irradiation for T1-4 N0 M0 SCCHN of the oral cavity, oropharynx, hypopharynx, or larynx who then subsequently developed a metachronous T1-4 N0 M0 SCCHN primary at a new site. All second primary tumors were treated with surgery. Ten of the 13 patients also received an elective neck dissection (END) at that time: 7 unilateral and 3 bilateral. We report the outcomes for the patients in this series.
  
  
  RESULTS
  One (8%) of 13 neck dissection specimens was positive in 1 (10%) of 10 patients. The 5-year outcomes were the following: local-regional control, 67%; local control, 77%; disease-free survival, 62%; overall survival, 38%; and cause-specific survival rate, 77%. Six patients experienced treatment-related complications of grade 2 or higher (per Common Terminology Criteria for Adverse Events, version 4). Complications occurred exclusively in patients who received an END.
  
  
  CONCLUSIONS
  The risk of occult nodal disease may be low enough to justify omitting an END for a second primary SCCHN in selected patients while maintaining treatment efficacy and reducing patient morbidity. Larger studies on this subject are needed to further address this question.
authors.affiliation: Department of Radiation Oncology at the University of Florida College of Medicine, Gainesville, FL, USA
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Falchook
authors.forename: Roi
authors.initials: R
authors.lastname: Dagan
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome