Abstract
Objective
To determine the likelihood of pathologically positive neck dissections after primary chemoradiotherapy for advanced squamous cell carcinoma (SCC) of the head and neck, and to examine the impact of persistent neck disease on regional recurrence, distant metastasis, and survival.
Methods
57 patients with N2 and N3 neck disease undergoing primary chemoradiotherapy for SCC of the oral cavity, oropharynx, larynx, and hypopharynx who underwent post-treatment neck dissections (PND) from 1999–2007 at the University of Illinois Chicago were evaluated for clinical complete response (CCR) and pathologic complete response (PCR). CCR was determined by physical examination (PE) and CT findings performed 4 to 6 weeks after chemoradiotherapy. Positive predictive value (PPV) was defined as CCR predictive of PCR. We also determined the impact of pathologically positive PND on surgical complications, regional recurrence, distant metastasis, disease-free survival, and overall survival using the chi-squared and log-rank tests.
Results
Of the 57 patients who underwent neck dissections, 17 (30%) had pathologically positive neck dissection specimens. When PE and CT findings showed resolution of disease (CCR), 85% (PPV) of pathologic specimens demonstrated no residual cancer. Conversely, when CCR was not achieved, 40% (NPV) of pathologic specimens demonstrated residual cancer. Positive pathologic disease in PND was associated with worse overall survival (p=0.014).
Conclusions
Persistent neck disease is common in advanced head and neck patients undergoing primary chemoradiotherapy. Failure to achieve CCR increases the likelihood of pathologically positive neck specimens by more than two-fold.
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