Open Access Research article

Neck control after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancers

Na Young Jang1, Keun-Wook Lee2, Soon-Hyun Ahn3, Jae-Sung Kim1 and In-Ah Kim1*

Author Affiliations

1 Department of Radiation Oncology, Seoul National University Bundang Hospital, 300 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea

2 Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea

3 Otorhinolaryngology, Seoul National University Bundang Hospital, 300 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea

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BMC Cancer 2012, 12:59  doi:10.1186/1471-2407-12-59

Published: 7 February 2012

Abstract

Background

The purpose of this study was to evaluate neck control outcomes after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancer.

Methods

We retrospectively reviewed medical records of fifty patients with node-positive head and neck cancer who received definitive radiochemotherapy. Twelve patients subsequently underwent neck dissection for suspicious recurrent or persistent disease. A median dose of 70 Gy (range 60-70.6) was delivered to involved nodes. Response evaluation was performed at a median of 5 weeks after completion of radiotherapy.

Results

Neck failure was observed in 11 patients and the 3-year regional control (RC) rate was 77.1%. Neck dissection was performed in 10 of the 11 patients; seven of these cases were successfully salvaged, and the ultimate rate of neck control was 92%. The remaining two patients who received neck dissection had negative pathologic results. On univariate analysis, initial nodal size > 2 cm, a less-than-complete response at the primary site, post-radiotherapy nodal size > 1.5 cm, and post-radiotherapy nodal necrosis were associated with RC. On multivariate analysis, less-than-complete primary site response and post-radiotherapy nodal necrosis were identified as independent prognostic factors for RC.

Conclusions

The neck failure rate after definitive radiochemotherapy without planned neck dissection was 22%. Two-thirds of these were successfully salvaged with neck dissection and the ultimate neck control rate was 92%. Our results suggest that planned neck dissection might not be necessary in patients with complete response of primary site, no evidence of residual lesion > 1.5 cm, or no necrotic lymph nodes at the 1-2 months follow-up evaluation after radiotherapy.