title: The role of initial neck dissection for patients with node-positive oropharyngeal squamous cell carcinomas.
abstract: BACKGROUND
  The current study sought to assess the role of initial neck dissection (ND) for patients with node-positive oropharyngeal squamous cell carcinomas (OPSCC).
  
  
  METHODS
  The data for 202 patients with previously untreated node-positive OPSCC were gathered from 12 institutions belonging to the Head and Neck Cancer Study Group in the Japan Clinical Oncology Group. These patients were categorized into two groups, consisting of the initial ND group and the wait-and-see group, according to treatment policy.
  
  
  RESULTS
  Regional recurrence was observed in 17 of 93 patients undergoing initial ND, whereas, recurrent or persistent diseases were observed in 40 of 109 patients who did not undergo initial ND. The 4-year overall survival rates (OS) for the wait-and-see group and initial ND groups were 74.0% and 78.7%, respectively, and the 4-year regional control rates (RC) for each group were 77.6% and 84.9%. There were no significant differences in either OS or RC (p=0.3440 and p=0.2382, respectively). However, for patients with N3 disease, the 4-year OS of the initial ND group (100%) was favorable. For patients with N2a disease, the 4-year RC of the initial ND group was higher than that of the wait-and-see group statistically (100% vs 62.5%, p=0.0156).
  
  
  CONCLUSIONS
  The role of initial ND was limited in patients with node-positive OPSCC. The treatment strategy not involving initial ND is considered feasible and acceptable when nodal evaluation after definitive radiotherapy or chemoradiotherapy is applied adequately. However, it is possible that initial ND improves outcomes in patients with resectable large-volume nodal disease.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address: t-sakashita@med.hokudai.ac.jp.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sakashita
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Homma
authors.affiliation: Division of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Hayashi
authors.affiliation: Department of Head and Neck Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kawabata
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Yoshino
authors.affiliation: Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan.
authors.forename: Shigemichi
authors.initials: S
authors.lastname: Iwae
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center, Nagoya, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Hasegawa
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nibu
authors.affiliation: Department of Oto-Rhino-Laryngology, Jikei University School of Medicine, Sendai, Japan.
authors.forename: Takakuni
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Iwate Medical University Hospital, Morioka, Japan.
authors.forename: Kiyoto
authors.initials: K
authors.lastname: Shiga
authors.affiliation: Division of Head and Neck Surgery, Miyagi Cancer Center, Sendai, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Matsuura
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, National Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Nobuya
authors.initials: N
authors.lastname: Monden
authors.affiliation: Department of Otorhinolaryngology, National Tokyo Medical Center, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Fujii
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D037981:Neck Dissection / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009959:Oropharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Chemoradiotherapy; Planned neck dissection; Regional control; Regional recurrence; Salvage neck dissection