title: Modified radical neck dissection for residual neck disease after radiotherapy of nasopharyngeal carcinoma.
abstract: OBJECTIVE
  Although radical neck dissection is proposed as a standard salvage procedure for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck, modified radical neck dissection may be appropriate for select patients. This study was designed to evaluate the efficacy of individualized neck dissections based on preoperative imaging studies and intraoperative exploration for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck.
  
  
  METHODS
  The study included 42 consecutive patients who failed radiotherapy or chemo-radiotherapy for nasopharyngeal carcinoma of the neck and underwent a total of 46 radical neck dissections or modified radical neck dissections. Selection of the proper type of neck dissection was based on preoperative imaging studies and intraoperative exploration. The patients' clinical features, pathologic characteristics, complications, and treatment outcome were estimated and analyzed.
  
  
  RESULTS
  Radical neck dissection and modified radical neck dissection were performed on 19 and 27 necks, respectively. Thirty-three necks (71.7%) had multiple node metastases. Nineteen necks (41.3%) had node metastases at two or more levels. The overall morbidity rate was 11.9%. The 5-year neck control rate (NCR) was 79.1% for 46 necks. The 5-year overall survival and disease free survival for 42 patients were 58.0% and 44.0%, respectively. No statistically significant differences were found in comparing OS, DFS, NCR between the MRND and RND groups.
  
  
  CONCLUSIONS
  Individualized neck dissection based on preoperative imaging studies and intraoperative exploration is appropriate for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck.
authors.affiliation: Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou City, Guangdong Province 515031, China. Electronic address: penghanwei@126.com.
authors.forename: Hanwei
authors.initials: H
authors.lastname: Peng
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post St, 3rd Floor, San Francisco, CA 94115, United States.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Wang
authors.affiliation: Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou City, Guangdong Province 515031, China.
authors.forename: Xihong
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou City, Guangdong Province 515031, China.
authors.forename: Jianying
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou City, Guangdong Province 515031, China.
authors.forename: Haipeng
authors.initials: H
authors.lastname: Guo
authors.affiliation: Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou City, Guangdong Province 515031, China.
authors.forename: Muyuan
authors.initials: M
authors.lastname: Liu
mesh_terms: D000328:Adult; D002277:Carcinoma; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000628:therapy*; D037981:Neck Dissection / Q000379:methods*; D018365:Neoplasm, Residual; D011446:Prospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
keywords: Lymph node metastasis; Nasopharyngeal carcinoma; Neck dissection; Radiotherapy; Recurrence