Effectiveness of Superselective and Selective Neck Dissection for Advanced Nodal Metastases After Chemoradiation

Abstract

To determine the efficacy of selective and superselective neck dissection for patients with bulky or residual nodal metastasis treated with concomitant intraarterial cisplatin and radiotherapy.

X-ray Irradiation Altered Chemosensitivity of a p53-null Non-small Cell Lung Cancer Cell Line

“…Administering a high dose of cisplatin by conventional intravenous injection is not easy, but intra-arterial administration has proven feasible for treating head-and-neck cancers, in which p53 is mutated in about 50% of patients (Boyle et al, 1993;Brennan et al, 1995). The results of intra-arterial infusions of drugs combined with radiotherapy have also been quite impressive (Robbins et al, 2005;Homma et al, 2005).…”

Salvage Neck Dissection after Chemoradiation in Head and Neck Cancer: Practice and Pitfalls

“…19 At this juncture, it is important to revisit the frequency of pathologic residual carcinoma in ND specimens which ranges from 20 and 68% and is affected by many factors including pretreatment nodal stage and bulk, radiation dose and technique, the use of chemotherapy, the timing and extent of ND, and most importantly clinical response to CRT or patient selection. [16][17][18][19] Most authors prefer the planned dissection in all patients with evidence of clinical or radiological evidence of residual disease in neck, while prophylactic ND after complete response is done in N3 and rarely for N2 or N1 disease. Usually patients with complete response both clinically and radiologically are preferred for close observation especially with initial N2 or N1 nodes.…”

“…16 CRT has become an important treatment option for locally advanced head and neck cancer. When compared with radiation therapy alone, the results have shown significant improvement in locoregional disease control and some modest improvement in overall survival.…”

“…The rates of overall survival and distant metastases were not significantly different among the three ND subsets. 16 In another study performed by the same group of Robbins et al, they evaluated 177 node positive patients of head and neck cancer. Out of them, 81 had partial response after CRT and 73 had residual adenopathy involving only one neck node level.…”

Radical neck dissection: is it still indicated?

“…Consequently, in HNSCC with advanced N2-N3 status treated by chemoradiation, SND and even super SND, limited to one or two levels, are suitable in most cases. Using this approach, complications are limited and oncologic outcomes are optimal [28][29][30][31][32][33].…”