title: Neck dissection followed by definitive radiotherapy for small upper aerodigestive tract squamous cell carcinoma, with advanced neck disease: an alternative treatment strategy.
abstract: Treatment options for patients with small upper aerodigestive tracts squamous cell carcinoma (T1, T2) with advanced neck disease (N2, N3) is a topic that generates controversy in terms of thereuptic stratagies. We present the retrospective analysis of 109 patients treated, between 1991 and 2008, by "Neck dissection first approach" for N2, N3 neck node, followed by external beam radiotherapy (RT) with or without chemotherapy for the operated neck and the primary, deemed radiocurable. 94 patients completed the planned treatment and formed the material for this study. The primary (tumor) stage was as follows: T1 (29) and T2 (65) commonly arising from oropharynx; the neck nodes were predominantly N2a (n = 54), followed by N2b (n = 26) and N3 (n = 14) disease. Complete nodal clearence was achieved in 89 patients, with no major post operative complications. With a median follow up of 24 months disease free survival of 70% and overall survival of 61% at 5 years. Recurrence at primary site was noted predominantly with pyriform fossa tumors (n = 8), followed by base of tongue (n = 5) and were T2 lesions. Failure in the neck was seen in predominantly N3 nodes, R1 resection and failure to comply with adjuvant treatment. Neck dissection first approach is a valid treatment option that allows a good control of the disease in the neck, where it often fails if only RT is administered, along with preserving the pharyngolaryngeal function. Care should be excercised so that there should be no delay in initiating the RT following surgery.
authors.affiliation: Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Dr.M.H.Marigowda Road, 560029 Bangalore, Karnataka India.
authors.forename: Ashok M
authors.initials: AM
authors.lastname: Shenoy
authors.affiliation: Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Dr.M.H.Marigowda Road, 560029 Bangalore, Karnataka India.
authors.forename: T
authors.initials: T
authors.lastname: Shiva Kumar
authors.affiliation: Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Dr.M.H.Marigowda Road, 560029 Bangalore, Karnataka India.
authors.forename: V
authors.initials: V
authors.lastname: Prashanth
authors.affiliation: Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Dr.M.H.Marigowda Road, 560029 Bangalore, Karnataka India.
authors.forename: Purushotham
authors.initials: P
authors.lastname: Chavan
authors.affiliation: Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Dr.M.H.Marigowda Road, 560029 Bangalore, Karnataka India.
authors.forename: Rajshekar
authors.initials: R
authors.lastname: Halkud
authors.affiliation: Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India.
authors.forename: Linu
authors.initials: L
authors.lastname: Jacob
authors.affiliation: Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India.
authors.forename: K
authors.initials: K
authors.lastname: Govind Babu
authors.affiliation: Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India.
authors.forename: G
authors.initials: G
authors.lastname: Lokesh
authors.affiliation: Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Pasha
authors.affiliation: Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India.
authors.forename: Rekha V
authors.initials: RV
authors.lastname: Kumar
keywords: Neck dissection; Neck nodes; Radiotherapy; UADT cancer