title: Outcomes following chemoradiotherapy for N3 head and neck squamous cell carcinoma without a planned neck dissection.
abstract: OBJECTIVE
  The optimal management of the N3 neck in head and neck squamous cell carcinoma (HNSCC) remains controversial. We report the outcomes of patients with N3 disease treated with a strategy of concurrent chemo-radiotherapy (CRT)±induction chemotherapy (ICT) without a planned neck dissection.
  
  
  METHODS
  Forty patients with HNSCC N3 disease treated between January 2004 and December 2010 were retrospectively identified. Inclusion criteria for the study were: non-nasopharyngeal HNSCC, N3 nodal disease, intention to treat with CRT±ICT.
  
  
  RESULTS
  Median age was 60 (range 39-74). Median follow up was 32 months (range 8-88). 34 (85%) of patients received ICT. 35 patients received cisplatin-CRT, 4 carboplatin-CRT and 1 patient was treated with radiotherapy alone due to ICT toxicity. 27 (67.5%) patients had a complete response (CR) to CRT. 5 (12.5%) patients had an incomplete response in both the primary and nodal sites. 8 (20%) patients had a CR in the primary site but incomplete in the nodal regions. The crude rate of regional failure following a CR was 3/27 (11.2%). Isolated regional failure occurred in 1/27 (3.7%) patients who had achieved a CR post-CRT. 3 year overall survival, disease free survival, locoregional control, local control and regional control in the whole cohort were 51.4%, 49.6%, 65.7%, 77.3%, 69.3%, and in patients with a CR were 73.3%, 70.0%, 86.6%, 90.5% and 91.7% respectively.
  
  
  CONCLUSIONS
  Isolated regional nodal failure is rare following a complete response to CRT for N3 HNSCC managed without a planned neck dissection.
authors.affiliation: Department of Clinical Oncology, St. James's Institute of Oncology, Beckett Street, Leeds LS9 7TF, United Kingdom.
authors.forename: Ebru
authors.initials: E
authors.lastname: Karakaya
authors.forename: Ozlem
authors.initials: O
authors.lastname: Yetmen
authors.forename: Didem Colpan
authors.initials: DC
authors.lastname: Oksuz
authors.forename: Karen E
authors.initials: KE
authors.lastname: Dyker
authors.forename: Catherine
authors.initials: C
authors.lastname: Coyle
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sen
authors.forename: Robin J D
authors.initials: RJ
authors.lastname: Prestwich
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D000077143:Docetaxel; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D060828:Induction Chemotherapy; D008198:Lymph Nodes / Q000187:drug effects / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009367:Neoplasm Staging; D020266:Radiotherapy, Conformal; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel; D016190:Carboplatin; D002945:Cisplatin; D005472:Fluorouracil