Anuj Goenka, Luc G.T. Morris, Shyam S. Rao, Suzanne L. Wolden, Richard J. Wong, Dennis H. Kraus, Nisha Ohri, Jeremy Setton, Benjamin H. Lok, Nadeem Riaz, Borys R. Mychalczak, Heiko Schoder, Ian Ganly, Jatin P. Shah, David G. Pfister, Michael J. Zelefsky and Nancy Y. Lee Long-term regional control in the observed neck following definitive chemoradiation for node-positive oropharyngeal squamous cell cancer International Journal of Cancer 133
Traditionally, most patients with head and neck cancer and nodal metastases who are treated with chemoradiotherapy undergo a neck dissection after treatment in order to remove residual metastatic disease in the neck. However, not all of these patients' necks actually harbor residual disease. In fact, emerging data now reveals that patients who experience a complete response after chemoradiation therapy have a very low rate of residual disease identified in the neck. Furthermore, a PET/CT scan obtained after treatment is a highly accurate predictor of whether there will be any residual disease in neck lymph nodes. These findings have led many to hypothesize that patients achieving a complete response might not require post-treatment neck dissections. The current study now presents the first comprehensive analysis of a large, uniform cohort of node-positive head and neck cancer patients undergoing observation of the neck rather than neck dissection, provided that PET/CT indicates that a complete response after chemoradiation has been achieved. The rate of recurrence in these observed patients was very low, indicating that head and neck cancer patients experiencing a PET/CT-confirmed complete response after chemoradiation therapy can be safely observed, rather than undergoing neck dissection.
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