Selective versus comprehensive neck dissection after chemoradiation for advanced oropharyngeal squamous cell carcinoma
Presented as an oral presentation at the American Head and Neck Society Meeting, San Francisco, California, July 20, 2008.
Received 6 May 2009; received in revised form 14 September 2009; accepted 17 September 2009.
Abstract
Objective
To determine whether a comprehensive neck dissection (CND) or a selective neck dissection (SND) is indicated as planned post–primary chemoradiation treatment (CRT) for patients with advanced oropharyngeal squamous cell carcinoma (OPSCC).
Study Design
Case series with chart review.
Setting
A community teaching hospital.
Subjects
Patients with advanced OPSCC who received a uniform CRT protocol at Greater Baltimore Medical Center (GBMC).
Methods
Medical records of patients treated with primary CRT for locoregionally advanced OPSCC at GBMC between 2001 and 2007 were reviewed. All patients received 7000 to 7500, 6000, and 5000 cGy to primary disease sites, involved cervical lymphatics, and uninvolved cervical and supraclavicular lymphatics, respectively, with concomitant cisplatin (12 mg/m2/1 h) and 5-fluorouracil (600 mg/m2/20 h) given on days one through five and 29 through 33.
Results
Seventy-six patients received CRT, and 41 met the criteria for neck dissection. Forty-eight neck dissections were performed (34 unilateral and 7 bilateral), of which 23 (48%) were CNDs and 25 (52%) were SNDs. Residual carcinoma was found in six (26%) of the CND and five (20%) of the SND heminecks. The CND group had six (26%) complications, whereas the SND group had two (8%).
Conclusion
The high rate of residual disease demonstrated in this study supports the need for post-CRT neck dissection. Although complication rates were not significantly different between the two groups, the trend in this study indicates that SND results in less morbidity. The presumed reduced morbidity and equivalent regional control rate suggest that SND is an appropriate surgical option for OPSCC patients after primary CRT.
aDepartment of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, and the Johns Hopkins Head and Neck Surgery, Baltimore, MD
bDepartment of Pathology, Johns Hopkins University School of Medicine, and the Johns Hopkins Head and Neck Surgery, Baltimore, MD
cMilton J. Dance Jr. Head and Neck Center, Baltimore, MD
dGreater Baltimore Medical Center Cancer Center, Baltimore, MD
Corresponding author: Patrick K. Ha, MD, Assistant Professor, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, 1550 Orleans St, Rm 5m06, Cancer Research Building II, Baltimore, MD 21231
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
ABSTRACT