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Is Neck Dissection Necessary After Induction Plus Concurrent Chemoradiotherapy in Complete Responder Head and Neck Cancer Patients with Pretherapy Advanced Nodal Disease?

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The aim of the present study was to assess, in the setting of a single-institution prospective clinical trial, the necessity of planned neck dissection (PND) in physically and radiologically complete responders with pretherapy advanced nodal disease.

Methods

Between January 2000 and July 2007 a total of 139 patients were enrolled to receive a regimen of platinum-based multidrug induction-concurrent chemoradiotherapy (IC/CCRT). A total of 75 of the enrolled patients with advanced nodal disease were included in this retrospective study. Between 8 and 12 weeks from the end of treatment, the response to IC/CCRT was evaluated by fiber-optic endoscopy and head and neck contrast-enhanced computed tomography or magnetic resonance imaging.

Results

The complete clinical response (cCR) rate was 68 %. Among the 51 patients who achieved locoregional cCR at the end of CCRT, 8 underwent PND according to the study recommendation. Of the 43 patients with cCR who did not undergo PND, 2 patients (4.7 %) experienced isolated regional recurrences with the 5-year regional control being 82 %. Patients with cCR did not have a significantly lower regional control compared with patients with cCR who underwent ND (P = .962). Pathological evidence of residual disease was found in 81 % of the patients with less than cCR who underwent ND.

Conclusions

In physically and radiologically complete responders to IC/CCRT, a PND appears not justified. Conversely, PND should be performed in patients clinically suspected of having residual disease in the neck, as a significant proportion have viable tumor cell in post CCRT ND.

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Acknowledgments

We acknowledge 2 anonymous reviewers for providing helpful comments that improved the quality of this manuscript.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, Treviso Regional Hospital, University of Padua, Treviso, Italy

    Maria Cristina Da Mosto MD, Valentina Lupato MD & Paolo Boscolo-Rizzo MD

  2. Department of Pathology, Treviso Regional Hospital, Treviso, Italy

    Salvatore Romeo MD

  3. Head and Neck Department, ENT Clinic, Hospital of Cattinara, University of Trieste, Trieste, Italy

    Giacomo Spinato MD

  4. Department of Radiology, Treviso Regional Hospital, Treviso, Italy

    Giancarlo Addonisio MD

  5. Department of Radiation Oncology, Treviso Regional Hospital, Treviso, Italy

    Vittorio Baggio MD & Alessandro Gava MD

Authors
  1. Maria Cristina Da Mosto MD
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  2. Valentina Lupato MD
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  4. Giacomo Spinato MD
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  7. Alessandro Gava MD
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  8. Paolo Boscolo-Rizzo MD
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Correspondence to Paolo Boscolo-Rizzo MD.

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Da Mosto, M.C., Lupato, V., Romeo, S. et al. Is Neck Dissection Necessary After Induction Plus Concurrent Chemoradiotherapy in Complete Responder Head and Neck Cancer Patients with Pretherapy Advanced Nodal Disease?. Ann Surg Oncol 20, 250–256 (2013). https://doi.org/10.1245/s10434-012-2520-2

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  • DOI: https://doi.org/10.1245/s10434-012-2520-2

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