Neck control after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancers.
BACKGROUND
The purpose of this study was to evaluate neck control outcomes after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancer.


METHODS
We retrospectively reviewed medical records of fifty patients with node-positive head and neck cancer who received definitive radiochemotherapy. Twelve patients subsequently underwent neck dissection for suspicious recurrent or persistent disease. A median dose of 70 Gy (range 60-70.6) was delivered to involved nodes. Response evaluation was performed at a median of 5 weeks after completion of radiotherapy.


RESULTS
Neck failure was observed in 11 patients and the 3-year regional control (RC) rate was 77.1%. Neck dissection was performed in 10 of the 11 patients; seven of these cases were successfully salvaged, and the ultimate rate of neck control was 92%. The remaining two patients who received neck dissection had negative pathologic results. On univariate analysis, initial nodal size > 2 cm, a less-than-complete response at the primary site, post-radiotherapy nodal size > 1.5 cm, and post-radiotherapy nodal necrosis were associated with RC. On multivariate analysis, less-than-complete primary site response and post-radiotherapy nodal necrosis were identified as independent prognostic factors for RC.


CONCLUSIONS
The neck failure rate after definitive radiochemotherapy without planned neck dissection was 22%. Two-thirds of these were successfully salvaged with neck dissection and the ultimate neck control rate was 92%. Our results suggest that planned neck dissection might not be necessary in patients with complete response of primary site, no evidence of residual lesion > 1.5 cm, or no necrotic lymph nodes at the 1-2 months follow-up evaluation after radiotherapy.
Department of Radiation Oncology, Seoul National University Bundang Hospital, 300 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea.
Na Young
NY
Jang
Keun-Wook
KW
Lee
Soon-Hyun
SH
Ahn
Jae-Sung
JS
Kim
In Ah
IA
Kim
D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D017211:Treatment Failure