BACKGROUND: The role of neck dissection (ND) after definitive chemoradiotherapy for squamous cell head and neck cancer is incompletely defined. We retrospectively reviewed 109 patients with N2-N3 disease treated with chemoradiotherapy to identify predictors of a clinical complete response in the neck (CCR-neck), pathologic complete response after ND (PCR-neck), and regional failure. METHOD: All patients were given 4-day continuous infusions of 5-fluorouracil (1000 mg/m2/d) and cisplatin (20 mg/m2/d) during the first and fourth weeks of either once daily (n = 68) or twice daily (n = 41) radiation therapy. ND was considered for all patients after completion of chemoradiotherapy and was performed in 32 of the 65 patients achieving a CCR-neck after chemoradiotherapy and in all 44 patients with residual clinical evidence of neck disease. CCR-neck, PCR-neck, and regional failure were then correlated with potential predictors, including T, N, largest lymph node size (<3 cm, > or =3 cm), primary tumor site, and radiation fractionation schedule. RESULTS: Achievement of a CCR-neck was predicted by N, N2 vs N3 (53 of 80 vs 12 of 29, p =.019) and by largest lymph node size, <3 cm vs > or =3 cm (19 of 25 vs 46 of 84, p =.06). Achievement of a PCR-neck could not be predicted by any clinical parameter. Regional failure occurred both in patients undergoing ND and those not dissected (5 of 76 vs 4 of 33, p =.33) and proved more likely only in the ND patients with residual positive pathology compared with those achieving a PCR-neck (5 of 25 vs 0 of 51, p <.001). Primary site was not a useful predictor of CCR-neck, PCR-neck, or regional failure. Most importantly, CCR-neck (vs <CCR-neck) did not predict either a PCR-neck (24 of 32 vs 27 of 44, p =.21) or regional failure (5 of 65 vs 4 of 44, p =.80). CONCLUSIONS: After chemoradiotherapy, clinical parameters do not identify those patients with residual neck node disease or those at risk for regional failure, suggesting that ND be considered for all N2-N3 patients. Copyright 2003 Wiley Periodicals, Inc.
BACKGROUND: The role of neck dissection (ND) after definitive chemoradiotherapy for squamous cell head and neck cancer is incompletely defined. We retrospectively reviewed 109 patients with N2-N3 disease treated with chemoradiotherapy to identify predictors of a clinical complete response in the neck (CCR-neck), pathologic complete response after ND (PCR-neck), and regional failure. METHOD: All patients were given 4-day continuous infusions of 5-fluorouracil (1000 mg/m2/d) and cisplatin (20 mg/m2/d) during the first and fourth weeks of either once daily (n = 68) or twice daily (n = 41) radiation therapy. ND was considered for all patients after completion of chemoradiotherapy and was performed in 32 of the 65 patients achieving a CCR-neck after chemoradiotherapy and in all 44 patients with residual clinical evidence of neck disease. CCR-neck, PCR-neck, and regional failure were then correlated with potential predictors, including T, N, largest lymph node size (<3 cm, > or =3 cm), primary tumor site, and radiation fractionation schedule. RESULTS: Achievement of a CCR-neck was predicted by N, N2 vs N3 (53 of 80 vs 12 of 29, p =.019) and by largest lymph node size, <3 cm vs > or =3 cm (19 of 25 vs 46 of 84, p =.06). Achievement of a PCR-neck could not be predicted by any clinical parameter. Regional failure occurred both in patients undergoing ND and those not dissected (5 of 76 vs 4 of 33, p =.33) and proved more likely only in the NDpatients with residual positive pathology compared with those achieving a PCR-neck (5 of 25 vs 0 of 51, p <.001). Primary site was not a useful predictor of CCR-neck, PCR-neck, or regional failure. Most importantly, CCR-neck (vs <CCR-neck) did not predict either a PCR-neck (24 of 32 vs 27 of 44, p =.21) or regional failure (5 of 65 vs 4 of 44, p =.80). CONCLUSIONS: After chemoradiotherapy, clinical parameters do not identify those patients with residual neck node disease or those at risk for regional failure, suggesting that ND be considered for all N2-N3 patients. Copyright 2003 Wiley Periodicals, Inc.
Authors: Benjamin J Moeller; Vishal Rana; Blake A Cannon; Michelle D Williams; Erich M Sturgis; Lawrence E Ginsberg; Homer A Macapinlac; J Jack Lee; K Kian Ang; K S Clifford Chao; Gregory M Chronowski; Steven J Frank; William H Morrison; David I Rosenthal; Randal S Weber; Adam S Garden; Scott M Lippman; David L Schwartz Journal: Int J Radiat Oncol Biol Phys Date: 2010-02-18 Impact factor: 7.038
Authors: S S Yom; A S Garden; G A Staerkel; L E Ginsberg; W H Morrison; E M Sturgis; D I Rosenthal; J N Myers; B S Edeiken-Monroe Journal: AJNR Am J Neuroradiol Date: 2011-07-14 Impact factor: 3.825
Authors: A Relic; M Scheich; J Stapf; C Voelter; F Hoppe; R Hagen; L Pfreundner Journal: Eur Arch Otorhinolaryngol Date: 2009-03-14 Impact factor: 2.503
Authors: Benjamin J Moeller; Vishal Rana; Blake A Cannon; Michelle D Williams; Erich M Sturgis; Lawrence E Ginsberg; Homer A Macapinlac; J Jack Lee; K Kian Ang; K S Clifford Chao; Gregory M Chronowski; Steven J Frank; William H Morrison; David I Rosenthal; Randal S Weber; Adam S Garden; Scott M Lippman; David L Schwartz Journal: J Clin Oncol Date: 2009-03-30 Impact factor: 44.544