Get access

Planned Neck Dissection after Concomitant Radiochemotherapy for Advanced Head and Neck Cancer

Authors

  • Douglas K. Frank MD,

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery, Beth Israel Medical Center and The Institute for Head and Neck Cancer, New York, New York
    • Dr. Douglas K. Frank, Beth Israel Medical Center, Department of Otolaryngology—Head and Neck Surgery, Phillips Ambulatory Care Center, 10 Union Square East, Suite 4J, New York, NY 10003, U.S.A.
    Search for more papers by this author
  • Kenneth S. Hu MD,

    1. Department of Radiation Oncology, Beth Israel Medical Center and The Institute for Head and Neck Cancer, New York, New York
    Search for more papers by this author
  • Bruce E. Culliney MD,

    1. Department of Medical Oncology, Beth Israel Medical Center and The Institute for Head and Neck Cancer, New York, New York
    Search for more papers by this author
  • Mark S. Persky MD,

    1. Department of Otolaryngology—Head and Neck Surgery, Beth Israel Medical Center and The Institute for Head and Neck Cancer, New York, New York
    Search for more papers by this author
  • Moses Nussbaum MD,

    1. Surgery, Beth Israel Medical Center and The Institute for Head and Neck Cancer, New York, New York
    Search for more papers by this author
  • Stimson P. Schantz MD,

    1. Department of Otolaryngology—Head and Neck Surgery, The New York Eye and Ear Infirmary, New York, New York, U.S.A.
    Search for more papers by this author
  • Stephen C. Malamud MD,

    1. Department of Medical Oncology, Beth Israel Medical Center and The Institute for Head and Neck Cancer, New York, New York
    Search for more papers by this author
  • Roy A. Holliday MD,

    1. Radiology, Beth Israel Medical Center and The Institute for Head and Neck Cancer, New York, New York
    Search for more papers by this author
  • Azita S. Khorsandi MD,

    1. Radiology, Beth Israel Medical Center and The Institute for Head and Neck Cancer, New York, New York
    Search for more papers by this author
  • Roy B. Sessions MD,

    1. Department of Otolaryngology—Head and Neck Surgery, Beth Israel Medical Center and The Institute for Head and Neck Cancer, New York, New York
    Search for more papers by this author
  • Louis B. Harrison MD

    1. Department of Radiation Oncology, Beth Israel Medical Center and The Institute for Head and Neck Cancer, New York, New York
    Search for more papers by this author

  • Presented at the 6th International Conference on Head and Neck Cancer, Washington, DC, August 7–11, 2004.

Abstract

Objectives/Hypothesis: Since 1998, at our academic, multidisciplinary head and neck cancer treatment center, it has been our policy to treat appropriate patients with locoregionally advanced squamous cell carcinoma of the head and neck (SCCHN) with concomitant radiochemotherapy followed within 6 weeks by planned neck dissection(s). Our objective was to investigate the oncologic efficacy of planned neck dissection, to date, in this patient population with a focus on outcomes in the neck.

Study Design: Retrospective analysis of a cumulative patient database.

Methods: The medical records of all patients who underwent planned neck dissection(s) after concomitant radiochemotherapy for locoregionally advanced SCCHN at Beth Israel Medical Center and The Institute for Head and Neck Cancer in New York City were reviewed. For each patient, preradiochemotherapy primary and neck stage, postradiochemotherapy/preneck dissection clinical and radiographic neck status, type of neck dissection(s) performed, pathologic status of the neck dissection specimen(s), length of follow-up (after planned neck dissection), disease status at last follow-up, and site(s) of recurrence were recorded. Local, regional, and distant disease control rates were calculated by the Kaplan-Meier method.

Results: Fifty-one planned neck dissections were performed on 39 radiochemotherapy patients (12 patients had bilateral operations) between early 1998 and October, 2003. Thirty-two (82%) patients had N2 or greater neck disease, with 29 (74%) having T3/T4 disease at various upper aerodigestive tract primary sites. Patients received an average of 6,700 cGy and 6,000 cGy external beam radiation therapy to primary disease sites and involved cervical lymphatics respectively, concomitant with one of three platinum-based chemotherapy schedules. At a mean follow-up time of 24 (range 8–57) months for the entire study population, there has been only one neck recurrence (N2A neck). No patient with N2B (n = 11), N2C (n = 13, with majority of heminecks staged N2B), or N3 (n = 5) disease has recurred in the neck. No recurrences have occurred in the 41 heminecks (in 33 patients) where modified neck dissection (including 24 selective procedures) was performed despite the presence of residual carcinoma in 13 (32%) of these heminecks on pathologic review. Among all heminecks with residual carcinoma present (n = 18) in the neck dissection specimen, there has been only one neck recurrence. There have been no recurrences in the 26 heminecks (in 19 patients) with incomplete clinical response after radiochemotherapy despite the presence of residual carcinoma in 14 (54%) of these necks on pathologic review. The clinical and radiographic absence of residual disease after radiochemotherapy did not always predict a complete pathologic response. Surgical complications have been limited (1 chyle leak, 1 wound breakdown).

Conclusions: The integration of planned neck dissection into the multidisciplinary management of patients with locoregionally advanced SCCHN is highly effective in controlling cervical metastatic disease. Modified and selective neck dissection procedures can be performed in the majority of patients, regardless of the response in the neck subsequent to concomitant radiochemotherapy. We recommend a planned neck dissection(s) in all patients staged (pretreatment) with N2 or greater neck disease and in select N1 cases.

Get access to the full text of this article

Ancillary