Cervical lymph node metastases--diagnostic, therapeutic, and prognostic implications.

Patients with carcinoma of the upper aerodigestive tract presenting with cervical lymph node metastasis carry a poorer prognosis compared to those in whom the regional lymph nodes are uninvolved. Prognosis worsens as the volume of metastatic cancer in the cervical lymph nodes increases. While the classical treatment for these metastases has been a radical neck dissection, this operation produces significant esthetic and functional morbidity. Radiation therapy alone offers poor results when bulky disease in the neck is present. Fortunately, the combination of surgery and radiation therapy offers significant advantages, not only in terms of reduction of morbidity, but improvement of disease control. The author discusses the current debate over the extent of neck dissection and the advantages of pre- and post-operative radiation.