Evaluation of neck node response after radiotherapy: minimizing equivocal results

Abstract

About two-thirds of patients with head and neck squamous cell carcinoma(HNSCC)originatingfromthemucosal linings of the upper aerodigestive tract present with advanced stage disease. If the primary tumour is located in the pharynx or larynx, patients are generally treated with radiotherapy with or without chemotherapy. In patients with functionally unresectable HNSCC (resectable but high morbidity of surgical treatment expected) who are treated with this nonsurgical treatment, salvage surgery is kept in reserve in case residual disease occurs. The decision to perform a neck dissection following (chemo)radiotherapy isclear whenpatientshaveprovenresidual nodal disease in the neck. However, distinguishing between residual metastasis and radiotherapy sequelae is difficult in most patients with a residual neck mass, since posttreatment induration and fibrosis make accurate clinical assessment difficult. Because no reliable clinical parameters are available to predict pathological neck status after (chemo)radiotherapy, routine planned neck dissection is performed in many institutions. The integration of planned neck dissection into the multidisciplinary management of patients with locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy is highly effective in controlling residual neck nodal disease. However, in the majority of neck dissection specimens, no viable tumour cells are found. Moreover, neck dissection after radiotherapy is associated with a significant risk of wound healing problems and shoulder morbidity. On the other hand, late recurrences in the neck are rarely surgically salvageable and are associated with an increased risk of metastatic spread to distant sites. Therefore, early detection of residual neck disease after (chemo)radiotherapy is important [1–4].