The role of neck dissection after chemoradiotherapy for oropharyngeal cancer with advanced nodal disease

👉The role of neck dissection after chemoradiotherapy for oropharyngeal cancer with advanced nodal disease.

👉Clayman GL1, Johnson CJ 2nd, Morrison W, Ginsberg L, Lippman SM. Arch Otolaryngol Head Neck Surg. 2001;127(2):135-139. doi:10.1001/archotol.127.2.135

👉Objective:

1. To analyze and compare the effectiveness of sequential platinum-based chemotherapy and radiotherapy with and without selective neck dissection in patients with N2a and greater stage node-positive squamous cell carcinoma of the oropharynx.

👉Design

1. Nonrandomized controlled trial.

👉Setting

1. Tertiary referral center.

👉Patients:

1. Sixty-six patients with squamous cell carcinoma of the oropharynx staged N2a or greater.

👉Interventions:

1. Platinum-based induction chemotherapy followed by definitive radiation therapy and selective neck dissections 6 to 10 weeks following the completion of radiation therapy in patients with radiographic evidence suggesting residual neck disease.

👉Main Outcome Measures

1. Locoregional recurrence and disease-free survival.

👉Results

• Of the 66 patients:
  • 24 (36%) had complete responses:
    • In the primary local tumor (oropharynx) and regional disease (neck nodes):
      • As assessed clinically and radiographically.
    • These patients had lower rates of locoregional recurrence than did patients showing no or partial responses:
      • But the differences were not significant (P>.05).
• Of 18 patients undergoing neck dissection:
  • 10 (56%) had pathological evidence of residual tumor.
• Patients showing a complete response of regional and neck disease:
  • Had significantly improved disease-specific and overall survival (P = .01 for both) compared with patients showing no or partial responses of their neck disease.
• Patients with no or partial responses who underwent neck dissections:
  • Had significantly improved overall survival compared with similar patients who did not undergo neck dissections (P = .002).

👉Conclusions

• Even in patients with bulky nodal disease:
  • A complete response in the neck to sequential chemotherapy and radiotherapy may indicate that neck surgery is not necessary for good locoregional control and improved disease-free survival.
• Neck dissection is recommended for patients with no or partial radiographic responses.

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