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Lymph node-positive head and neck cancer treated with definitive radiotherapy

Can treatment response determine the extent of neck dissection?

  1. Anamaria R. Yeung MD1,
  2. Stanley L. Liauw MD2,
  3. Robert J. Amdur MD1,
  4. Anthony A. Mancuso MD3,
  5. Russell W. Hinerman MD1,
  6. Christopher G. Morris MS1,
  7. Douglas B. Villaret MD4,
  8. John W. Werning MD4,
  9. William M. Mendenhall MD1,†,*

Article first published online: 10 JAN 2008

DOI: 10.1002/cncr.23279

Issue

Cancer

Cancer

Volume 112, Issue 5, pages 1076–1082, March 2008

Additional Information

How to Cite

Yeung, A. R., Liauw, S. L., Amdur, R. J., Mancuso, A. A., Hinerman, R. W., Morris, C. G., Villaret, D. B., Werning, J. W. and Mendenhall, W. M. (2008), Lymph node-positive head and neck cancer treated with definitive radiotherapy. Cancer, 112: 1076–1082. doi: 10.1002/cncr.23279

Author Information

  1. 1

    Department of Radiation Oncology, University of Florida, Gainesville, Florida

  2. 2

    Department of Radiation and Cellular Oncology at the University of Chicago, Chicago, Illinois

  3. 3

    Department of Radiology, University of Florida, Gainesville, Florida

  4. 4

    Department of Otolaryngology, University of Florida, Gainesville, Florida

  1. †

    Fax: (352) 265-0759

*Department of Radiation Oncology, University of Florida Health Science Center, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL 32610-0385

  1. †

    Fax: (352) 265-0759

Publication History

  1. Issue published online: 19 FEB 2008
  2. Article first published online: 10 JAN 2008
  3. Manuscript Accepted: 1 OCT 2007
  4. Manuscript Revised: 26 SEP 2007
  5. Manuscript Received: 6 JUN 2007

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Keywords:

  • lymph node-positive head and neck cancer;
  • radiotherapy;
  • neck dissection

Abstract

BACKGROUND

The purpose was to determine if postradiotherapy (RT) neck dissection can be limited to the neck levels of residual adenopathy on post-RT computed tomography (CT).

METHODS

In all, 274 patients with lymph node-positive head and neck squamous cell carcinoma were treated with definitive RT. All patients had a contrast-enhanced CT performed 4 weeks after completing RT to evaluate tumor response. Two hundred eleven heminecks were dissected, either planned pre-RT or because of residual adenopathy on post-RT CT. CT images were reviewed to determine the presence and location of residual adenopathy. Radiographic complete response (rCR) was defined as lymph node size ≤1.5 cm and normal radiographic morphology (no filling defects or calcifications). For each neck level the CT findings were correlated with neck dissection pathology.

RESULTS

Correlation of CT nodal response with neck dissection pathology revealed the following negative predictive values of rCR: level I, 100%; level II, 95%; level III, 98%; level IV, 96%; and level V, 96%. A subset analysis was performed on 61 neck levels with initially positive lymph nodes that completely responded to RT that were in a hemineck with residual lymphadenopathy elsewhere in the neck. Correlation of nodal response on CT to pathology indicated a negative predictive value of an rCR of 95% for this high-risk scenario. In 71 heminecks that underwent a selective neck dissection (defined as dissection of less than levels I-V) the 5-year neck control rate was 100%.

CONCLUSIONS

rCR on post-RT CT has a negative predictive value of ≥95% for each neck level. This suggests that limiting neck dissection based on post-RT CT is safe. Cancer 2008. © 2008 American Cancer Society.

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