title: Patterns of failure and histopathologic outcome predictors following definitive radiotherapy and planned neck dissection with residual disease.
abstract: BACKGROUND
  Our aim was to report patterns of failure and histopathological predictors in patients with head and neck cancer treated by planned neck dissection.
  
  
  METHODS
  We reviewed all new patients with head and neck cancer who underwent a planned neck dissection in our institution from 1998 to 2007. Patterns of failure after positive planned neck dissection were reported. The frequency and predictive value of histopathologic features were analyzed.
  
  
  RESULTS
  Fifty positive planned neck dissection and 144 negative planned neck dissection cases were identified. The positive planned neck dissection cohort had lower 5-year overall survival (OS; 33% vs 77%; p < .01), a significantly higher distant metastasis (DM; 44% vs 11%; p < .01), a moderately lower local (86% vs 96%; p < .01), and a similar regional control (94% vs 99%; p = .07) compared to the negative planned neck dissection cohort. Extracapsular extension/carcinoma within soft tissue and lymphovascular invasion were adverse survival predictors for patients with positive planned neck dissection on univariate and multivariate analysis.
  
  
  CONCLUSIONS
  Positive planned neck dissection is associated with lower survival, predominantly attributed to significantly increased DM rather than reduced locoregional control.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital/University of Toronto, Canada.
authors.forename: Shao Hui
authors.initials: SH
authors.lastname: Huang
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: Ilan
authors.initials: I
authors.lastname: Weinreb
authors.forename: Bayardo
authors.initials: B
authors.lastname: Perez-Ordonez
authors.forename: Jonathan
authors.initials: J
authors.lastname: Irish
authors.forename: John
authors.initials: J
authors.lastname: Waldron
authors.forename: Patrick
authors.initials: P
authors.lastname: Gullane
authors.forename: Ralph
authors.initials: R
authors.lastname: Gilbert
authors.forename: Dale
authors.initials: D
authors.lastname: Brown
authors.forename: Bernard
authors.initials: B
authors.lastname: Cummings
authors.forename: John
authors.initials: J
authors.lastname: Kim
authors.forename: Jeremy
authors.initials: J
authors.lastname: Freeman
authors.forename: Ian
authors.initials: I
authors.lastname: Witterick
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009362:Neoplasm Metastasis; D011379:Prognosis; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome