title: Incidence of nodal disease after nonsurgical therapy in head and neck squamous cell carcinoma patients with bilateral neck disease: can a bilateral neck dissection be avoided?
abstract: BACKGROUND
  We evaluated whether classifying 1 side of a patients' neck as "high risk" would help in deciding the extent of neck dissection in patients with bilateral nodal disease.
  
  
  METHODS
  We conducted a retrospective review of 44 patients (88 heminecks) with head and neck squamous cell carcinoma who had bilateral nodal disease and received definitive chemoradiotherapy (CRT). For lateralized lesions (70%), the ipsilateral neck was designated as the "high-risk" neck. For midline lesions, pre-CRT and post-CRT computed tomography scans were used to stage each side of the neck (hemineck); the higher staged hemineck was designated as the "high-risk" neck.
  
  
  RESULTS
  Twenty-seven patients had died at the time of analysis. Patients had a median follow-up of 27.8 months (range, 6 to 150 mo). Two-year neck control and overall survival were 83% and 56%, respectively. Sixty-two heminecks (71%) were dissected. A total of 6/22 (27%) "low-risk" necks were positive after CRT if the "high-risk" neck was positive versus 0/22 if the "high-risk" neck was negative (P=0.02).
  
  
  CONCLUSIONS
  Identifying the more "high-risk" neck may be useful when deciding the extent of neck dissection after CRT. For patients with bilateral nodal disease treated with CRT, dissection of the "low-risk" hemineck may be omitted if the "high-risk" neck is pathologically negative.
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC 27514, USA.
authors.forename: David
authors.initials: D
authors.lastname: Fried
authors.forename: Mark
authors.initials: M
authors.lastname: Weissler
authors.forename: Carol
authors.initials: C
authors.lastname: Shores
authors.forename: Marion
authors.initials: M
authors.lastname: Couch
authors.forename: Neil
authors.initials: N
authors.lastname: Hayes
authors.forename: Trevor
authors.initials: T
authors.lastname: Hackman
authors.forename: Adam
authors.initials: A
authors.lastname: Zanation
authors.forename: Bahjat
authors.initials: B
authors.lastname: Qaqish
authors.forename: Bhishamjit S
authors.initials: BS
authors.lastname: Chera
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D016896:Treatment Outcome