Esvaziamento ganglionar Cervical após QT/RT no IPO FGL

Abstract

Introduction: Radiotherapy and chemotherapy are treatment strategies for head and neck oncologic patients. In many cases they are the first line treatment, especially in locally advanced disease. Neck dissection would be done if the disease persisted after chemoradiotherapy. Controversy lies on the N2/N3 cases with total response due to difficult clinical, imagiological and histological evaluation. The sistematic pos chemoradiotherapy neck dissection defensors talk about a better regional disease control, and say that a clinical response doesn´t mean a remission. On the other side, the nech dissection on patients with residual disease defensors claim that after a complete clinical response the probability of a single regional recorrence is very small; for that, the systematic neck dissection would be an unnecessary cause of morbility. In IPO FGL neck dissection after chemoradiotherapy is performed if clinical or imagiological signs of persistente of disease are noticed. The imagiological evidence is evaluated with a cervical CT and/ or ecography 6 weeks after the chemoradiotherapy treatment; nowadays a PET scan is usually performed. Objective: to caracterize the head and neck oncologic patients with persistent disease after chemoradiotherapy leading to neck dissection for regional disease control. Material and methods: revision of 71 clinical records of patients who underwent neck dissection in 2001-2010; the patients who had local disease surgery, as inicial therapy or salvage therapy, were excluded. Twenty three patients who had chemoradiotherapy as first line treatment, and a posterior neck dissection because of persistent local disease, were selected. Results: From the selected group, 7 had a primary nasophraynx neoplasm, 7 a primary amigdala neoplasm, 7 a hypopharynx/ tongue base neoplasm and 1 a primary palatal tumor. The neck disease was N2/N3 in 74% of the cases. All of them had a cervical CT scan after chemoradiotherapy, 2 of them also had a PET scan. The histological exam of the ganglia dissected was positive for neoplasic cell in 83% of the patients. Conclusion: Neck dissection is importante in regional disease control and in the survival rates in head and neck cancer patients who have chemoradiotherapy as first line treatment. The results are satisfactory regarding the follow up eficacy, resulting in surgery in patients with persistent disease anf avoiding morbility in patients who wouldn´t have any benefict with surgical therapy.