BACKGROUND: Recently, the role of chemoradiotherapy (CRT) for preserving organs in the treatment of head and neck cancer has been increasing. However, the indication for post-CRT neck dissection (ND) and its surgical extent is still controversial. The purpose of this study was to discuss the indications for post-CRT ND and the proper extent of the surgical procedure. METHODS: We performed a retrospective analysis on N2-3 oropharyngeal and hypopharyngeal squamous cell carcinoma (OHSCC) patients treated with CRT in our institute from 1995 to 2008, and determined the prognostic impact of post-CRT ND and the distribution of cervical lymph node (CLN) metastasis based on the pathological results of ND. RESULTS: The patients without pathological CLN metastases had good prognoses, whereas patients with pathological CLN metastases exhibited a significantly high recurrence rate (P = 0.033). Based on the pathological results of ND, performing selective ND at levels II-IV can contain 88 and 85 % of CLN metastasis of the oropharynx and hypopharynx, respectively. In all cases, when pathological CLN metastases were found at level V in ND following CRT, distant metastases developed. CONCLUSIONS: The presence of pathological CLN metastasis affects prognosis, but also a diffuse distribution of CLN metastasis worsens prognosis; that is, the presence of CLN metastasis at level V after CRT appears to be an indicator of distant metastasis. Post-CRT ND may not make sense as a salvage intervention for improving the prognosis in such situations. We concluded that the proper extent of post-CRT ND of OHSCC is selective ND including levels II-IV.
BACKGROUND: Recently, the role of chemoradiotherapy (CRT) for preserving organs in the treatment of head and neck cancer has been increasing. However, the indication for post-CRT neck dissection (ND) and its surgical extent is still controversial. The purpose of this study was to discuss the indications for post-CRT ND and the proper extent of the surgical procedure. METHODS: We performed a retrospective analysis on N2-3 oropharyngeal and hypopharyngeal squamous cell carcinoma (OHSCC) patients treated with CRT in our institute from 1995 to 2008, and determined the prognostic impact of post-CRT ND and the distribution of cervical lymph node (CLN) metastasis based on the pathological results of ND. RESULTS: The patients without pathological CLNmetastases had good prognoses, whereas patients with pathological CLNmetastases exhibited a significantly high recurrence rate (P = 0.033). Based on the pathological results of ND, performing selective ND at levels II-IV can contain 88 and 85 % of CLN metastasis of the oropharynx and hypopharynx, respectively. In all cases, when pathological CLNmetastases were found at level V in ND following CRT, distant metastases developed. CONCLUSIONS: The presence of pathological CLN metastasis affects prognosis, but also a diffuse distribution of CLN metastasis worsens prognosis; that is, the presence of CLN metastasis at level V after CRT appears to be an indicator of distant metastasis. Post-CRT ND may not make sense as a salvage intervention for improving the prognosis in such situations. We concluded that the proper extent of post-CRT ND of OHSCC is selective ND including levels II-IV.
Authors: P Lavertu; D J Adelstein; J P Saxton; M Secic; J R Wanamaker; I Eliachar; B G Wood; M Strome Journal: Head Neck Date: 1997-10 Impact factor: 3.147
Authors: Susan Urba; Gregory Wolf; Avraham Eisbruch; Francis Worden; Julia Lee; Carol Bradford; Theodoros Teknos; Douglas Chepeha; Mark Prince; Norman Hogikyan; Jeremy Taylor Journal: J Clin Oncol Date: 2005-12-27 Impact factor: 44.544
Authors: Kerstin M Stenson; Dezheng Huo; Elizabeth Blair; Ezra E W Cohen; Athanassios Argiris; Daniel J Haraf; E Everett Vokes Journal: Laryngoscope Date: 2006-01 Impact factor: 3.325
Authors: James P Malone; Michael A T Gerberi; Syam Vasireddy; Larry F Hughes; Krishna Rao; Bruce Shevlin; Matthew Kuhn; Dean Collette; Joel Tennenhouse; K Thomas Robbins Journal: Arch Otolaryngol Head Neck Surg Date: 2009-11