Decision Making in Post‐chemoradiotherapy Neck Dissections

Abstract

Objective: There is continued debate as to whether to perform a neck dissection as a planned vs “wait and see” procedure in patients with head and neck cancer treated with chemoradiotherapy. In this study we aimed to review our results to help with the decision making process. Method: A retrospective review of 140 oropharyngeal cancer cases treated with chemoradiotherapy was performed. Demographic data and treatment outcomes were extracted. The patients who underwent neck dissections were selected and evaluated as to how the decision was made; this included clinical examination, imaging studies, and fine needle aspiration biopsy. Results: Of the 140 patients, 19 underwent ND for persistent disease. This included 9 patients with tonsil and 10 with base of tongue cancer. The decision for a ND was made according to CT scan findings in 7 patients, FNAB in 2 patients, PET imaging in 3 patients, clinical examination in 4 patients, and the combination of imaging and clinical findings in three patients. The dissections were performed at an average of 10 weeks (range, 4-20 weeks). Seven patients (37%) had no viable cancer in the ND specimen. The pre-treatment neck staging showed no significant difference. Conclusion: Head and neck surgeons are in search of reliable methods to determine patients at risk of persistent disease. In this series, 37% of the patients had no viable tumor in the ND specimen. Further studies are needed to identify patients who are not in need of a ND.