Treatment of advanced neck metastases.

Despite the use of aggressive single or multimodality treatment protocols, patients with advanced cervical metastases, N2 and N3, have a poor prognosis because of their high risk of regional and distal failure. Moreover, N3 class does not allow resectability and curability to be defined. Numerous trials have been carried out in order to improve the oncological outcomes of patients with advanced metastases to the neck using a variety of multimodality therapy. At present, there is a trend toward the use of a definitive radiochemotherapy followed, or not, by neck dissection. In order to offer a panoramic view of the treatment protocols in use, data available in the literature, regarding the management of advanced neck disease using surgery, radiotherapy and chemotherapy, in different associations, have been reviewed and our experience reported. The presence of advanced cervical metastases is a very poor prognostic factor. The combined treatment modality offers better chances of cure than single modality treatment. Surgery followed by radiotherapy or chemo-radiation therapy is an effective and well standardized approach. The use of planned neck dissection following chemoradiation is still debated.