Selective Neck Dissection in Node Positive Squamous Cell Carcinoma of Head and Neck

Abstract

Objective: Optimal type of neck dissection in head and neck squamous cell carcinoma HN(SCC) with clinically positive neck nodes has not been determined. The following study was performed to determine the rate of regional control with selective neck dissection (SND) in these patients. Method: HNSCC patients with cervical lymph node metastases who were treated with SND in a single institution from 2000 to 2010 were selected. Demographics, tumor characteristics, extent of neck dissection, prior and adjuvant treatments, locoregional control and survival were recorded. Recurrence in the neck and disease-specific survival (DSS) were primary and secondary endpoints. Results: A total of 130 patients underwent SND. A total of 84 (65%) were male. Median age was 62 years (range, 20-89 years). Most common primary site was oral cavity (64%). Twenty-one patients (16%) had prior treatments, 107 (82.3%) received adjuvant treatment. Median follow-up was 21 months. Fifteen patients (11.5%) had recurrence in dissected neck. Five-year neck recurrence-free survival (NRFS) was 82.5%. N2C disease patients had shorter NRFS (5-year: 64%). At the end of study 75 (58%) patients had NED and 32 (25%) had died of disease. Five-year DSS was 70%. Number of positive nodes, positive surgical margins, and perineural invasion were predictors of shorter DSS. Conclusion: Selective neck dissection in patients with cervical lymph node metastases from head and neck SCCs is effective in controlling the disease in the neck, when performed in the setting of multi-modality treatment including post operative radiotherapy.