Combined neck dissection and postoperative radiation therapy in the management of the high-risk neck: A matched-pair analysis

Abstract

Purpose : The purpose of this study was to determine the efficacy of postoperative adjuvant radiation therapy with regard to reducing the rate of recurrence in the neck, cancer-related death, and death from any cause in patients with squamous cell carcinoma of the head and neck region metastatic to neck nodes. Methods : This was retrospective review of patients with pathologically confirmed nodal metastases who underwent neck dissection and postoperative adjuvant radiation therapy for squamous cell carcinoma of the head and neck region. Time to recurrence in the dissection are of the neck, any recurrence in the neck, cancer-related death, and death from any cause were estimated with the Kaplan-Meier method. A matched-pair analysis was performed utilizing a cohort of patients who underwent neck dissection without postoperative radiation therapy. The patients from the two cohorts were matched according to previously reported high-risk features for cancer recurrence and death. Cox hazards models for the matched pairs were used to evaluate the relative risk of subsequent recurrence in the dissected side of the neck, any neck recurrence, cancer-related death, and overall survival. Materials : The medical records and pathologic slides of 95 consecutive patients with pathologically confirmed nodal metastases from squamous cell carcinoma of the head and neck region who underwent neck dissection and postoperative adjuvant radiation therapy between January 1974 and December 1990 were reviewed. Previously published data from 284 patients with squamous cell carcinoma of the head and neck region treated with neck dissection alone between January 1970 and December 1980 were used for a matched-pair analysis. Results : The relative risks for recurrence in the dissected side of the neck, any neck recurrence (discussed neck or delayed undissected neck metastasis), cancer-related death, and the death from any cause for patient treated with operation alone relative to those treated with operation and postoperative radition were 5.82, 4.72, 2.21, and 1.67, respectively. Conclusion : This study provides evidence that postoperative adjuvant radiation therapy for the high-risk neck can reduced the rate of recurrence with a dissected neck, delayed metastasis within an undissected neck, cancer-related death, and death from any cause.