Nodal Disease in Post‐chemoradiotherapy Neck Dissection

Abstract

Objective: 1) Determine the rate of residual neck node disease in patients with squamous cell carcinoma of the larynx, hypopharynx, and oropharynx undergoing neck dissection post-chemoradiation; and 2) Determine the impact on outcome. Method: Design: Retrospective case series. Patients: Thirty-three consecutive patients with residual neck disease following chemoradiotherapy for advanced stage laryngopharyngeal cancer were identified at a single institution between May 2003 and October 2007. Main outcome measure: Neck node pathological positivity, neck recurrence free survival, and disease specific survival. Results: Thirty-eight neck dissections were carried out in 33 patients (median ± STD age, 59 ± 7.8 years; 85% male). The oropharynx was the most common primary site (n = 27; 73%). The follow-up duration ranged from 9 to 61 months. Pathologically, 39.4% (13/33) of patients had viable tumor cells identified in dissection specimen. Three patients (9%) developed primary site recurrence. One patient (3%) died from local/regional disease and 2 patients (6%) died from distant metastasis. There was no statistically significant ( P = .37) increase in neck recurrence rate in the SND group when compared to the MRND and RND groups. Conclusion: Viable tumor results in poorer outcome even after complete resection by neck dissection.