title: Is neck dissection necessary after induction plus concurrent chemoradiotherapy in complete responder head and neck cancer patients with pretherapy advanced nodal disease?
abstract: BACKGROUND
  The aim of the present study was to assess, in the setting of a single-institution prospective clinical trial, the necessity of planned neck dissection (PND) in physically and radiologically complete responders with pretherapy advanced nodal disease.
  
  
  METHODS
  Between January 2000 and July 2007 a total of 139 patients were enrolled to receive a regimen of platinum-based multidrug induction-concurrent chemoradiotherapy (IC/CCRT). A total of 75 of the enrolled patients with advanced nodal disease were included in this retrospective study. Between 8 and 12 weeks from the end of treatment, the response to IC/CCRT was evaluated by fiber-optic endoscopy and head and neck contrast-enhanced computed tomography or magnetic resonance imaging.
  
  
  RESULTS
  The complete clinical response (cCR) rate was 68%. Among the 51 patients who achieved locoregional cCR at the end of CCRT, 8 underwent PND according to the study recommendation. Of the 43 patients with cCR who did not undergo PND, 2 patients (4.7%) experienced isolated regional recurrences with the 5-year regional control being 82%. Patients with cCR did not have a significantly lower regional control compared with patients with cCR who underwent ND (P=.962). Pathological evidence of residual disease was found in 81% of the patients with less than cCR who underwent ND.
  
  
  CONCLUSIONS
  In physically and radiologically complete responders to IC/CCRT, a PND appears not justified. Conversely, PND should be performed in patients clinically suspected of having residual disease in the neck, as a significant proportion have viable tumor cell in post CCRT ND.
authors: Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, Treviso Regional Hospital, University of Padua, Treviso, Italy.
authors: Maria Cristina
authors: MC
authors: Da Mosto
authors: Valentina
authors: V
authors: Lupato
authors: Salvatore
authors: S
authors: Romeo
authors: Giacomo
authors: G
authors: Spinato
authors: Giancarlo
authors: G
authors: Addonisio
authors: Vittorio
authors: V
authors: Baggio
authors: Alessandro
authors: A
authors: Gava
authors: Paolo
authors: P
authors: Boscolo-Rizzo
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D060828:Induction Chemotherapy; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D020266:Radiotherapy, Conformal; D016879:Salvage Therapy; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D002945:Cisplatin; D005472:Fluorouracil