Abstract
Objective: Clarify the effectiveness of planned neck dissection (PND) after concurrent chemoradiotherapy (CCRT), we investigated residual lymph node metastasis; imaging tests such as positron emission tomography (PET), computed tomography (CT), and ultrasonography at pre- and post-CCRT; and the adverse effects of PND.
Method: CCRT combined with PND was performed on 13 patients with oropharyngeal carcinoma, 4 with hypopharyngeal carcinoma, and 2 with laryngeal carcinoma. All primary lesions showed complete response to CCRT. Histopathologic examination of neck specimens and imaging tests were employed to evaluate the effect of CCRT.
Results: Eight of 19 patients (47%) had viable carcinoma in their lymph nodes. Patients with poorly differentiated carcinoma in the primary lesion tended to have residual lymph nodes. Most of the residual neck specimens belonged to the level III or level IV lymph node group. Major complications of PND were prolonged laryngeal edema, dysphasia, and disturbance of shoulder movement. Tracheotomies were performed in 42% of all cases. Positive and negative predictive values of PET examination before PND were 50% and 73%, respectively. None of the patients with PND experienced local or lymph node recurrence.
Conclusion: Residual lymph nodes were frequently observed in head and neck carcinomas. Of the imaging tests, PET was sufficient for detecting residual regions. Although PND is a useful tool, related complications were frequently observed. A more accurate detection system is needed to reduce unnecessary neck dissections.
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