title: Outcomes of head and neck squamous cell carcinoma patients with N3 neck disease treated primarily with chemoradiation versus surgical resection.
abstract: OBJECTIVE
  Although treatment paradigms have shifted to recommend primary chemoradiation therapy (CRT) for advanced head and neck squamous cell carcinoma, few studies include any significant number of patients with N3 (>6 cm) neck disease. The objective of this study was to determine if primary chemoradiation therapy has equivalent overall survival (OS) and disease-free survival (DFS) when compared to primary surgical resection in patients with N3 neck disease.
  
  
  METHODS
  Nonrandomized, single-institution, retrospective cohort study.
  
  
  METHODS
  Retrospective analysis of 100 patients treated for HNSCC with N3 neck disease between 1989 and 2009 was performed.
  
  
  RESULTS
  Patients who received primary surgery had better OS and DFS than those who had primary chemoradiation (P = .047), with a 5-year OS of 68% (95% confidence interval [CI], 45%-84%) versus 32% (95% CI, 19%-45%), and a 5-year DFS of 64% (95% CI, 41%-80%) versus 32% (95% CI, 19%-45%). Neck dissection following primary treatment with CRT did not improve OS. For patients with nonoropharyngeal squamous cell carcinoma with N3 neck disease, those who underwent primary surgery (n = 14) had significantly better OS than those who had primary CRT (n = 32, P = .02). Patients with oropharyngeal disease had better outcomes than other sites regardless of treatment modality, with 5-year OS of 54% (95% CI, 38%-68%) versus 32% (95% CI, 17%-47%, P = .02), but there was no statistical difference between patients treated with primary surgery versus CRT.
  
  
  CONCLUSIONS
  Patients with head and neck squamous cell cancer and N3 neck disease have at least equivalent survival with primary surgical treatment versus primary CRT. Primary surgical resection with appropriate adjuvant therapy should be considered for patients with resectable N3 disease, especially patients with nonoropharyngeal sites. Post-CRT neck dissections did not change the OS of patients with N3 disease.
authors: Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7070, USA. JKehren@unch.unc.edu
authors: Jessica K
authors: JK
authors: Smyth
authors: Allison M
authors: AM
authors: Deal
authors: Benjamin
authors: B
authors: Huang
authors: Mark
authors: M
authors: Weissler
authors: Adam
authors: A
authors: Zanation
authors: Carol
authors: C
authors: Shores
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome