Planned neck dissection following primary chemoradiation for advanced-stage head and neck cancer

Abstract

Objectives To determine the prevalence of residual cancer in planned neck dissection specimens for advanced-stage squamous cell carcinoma following chemoradiation. Study Design A case series. Setting A single-surgeon community-based head and neck practice. Subjects and Methods Twenty-six patients were identified during 2000 to 2007. All patients were treated with external beam radiation; the average dose to the neck was 60 Gy (range 50-72 Gy). Concurrent chemotherapy was given with cisplatin and 5-fluorouracil. Patients presenting with greater than N2 cervical disease and at least one node greater than 3 cm were considered advanced. Post-chemoradiation physical examinations were performed by the primary surgeon and oncologist. Absence of physical evidence of disease was deemed a complete clinical response. Results Fourteen of 21 (67%; 95% confidence interval [CI], 0.449-0.854) patients were found to have carcinoma in their neck specimens. Seven patients were noted to have a clinically complete response, and two of seven (29%; 95% CI, 0.053-0.659) patients with a clinically complete response were found to have carcinoma in their neck specimens. Fourteen patients were noted to have an incomplete response to therapy. Two of these 14 (14%; 95% CI, 0.026-0.419) patients had negative pathology in their neck dissection specimens. Three patients had local recurrence and succumbed to their disease. Conclusion Planned neck dissection in the setting of advanced neck disease following chemoradiation should remain an important consideration when counseling patients presenting with advanced cervical metastasis from squamous cell head and neck cancer.