Planned neck dissection before combined chemoradiation for pyriform sinus carcinoma

Abstract

The mean time between neck dissection and the chemoradiation was 24 days (+/-12 days). Only two patients (2.5%) experienced wound complications. A 'boost' radiation of 14 Gy was delivered after 49 neck dissections (61%) in patients with extracapsular spread. The rate of disease control within the regional nodes was 90%. The Kaplan-Meier 1- and 2- year overall survival rates were 78% and 43%, respectively, and specific survival rates were 88% and 67%, respectively.

Planned Neck Dissection before Combined Chemoradiation in Organ Preservation Protocol for N2-N3 of Supraglottic or Hypopharyngeal Carcinoma

“…The major wound complications that occurred were necrosis of the pharynx, neck, or both. Compared to cases with previous radiation therapy to the neck reported in the literature [25,26] , the incidence of postoperative complications in group A of our series was lower, and this was consistent with the results of Prades et al [2] . Proctor et al [26] compared the postoperative complications of patients with advanced head and neck cancer treated with chemoradiation protocol with those of a similar cohort of patients treated with primary surgery; there were local wound problems in 54 and 42%, respectively.…”

“…Recently, in an attempt to decrease the risk of delayed wound healing and complications and to get better neck node control, Prades et al [2] employed planned neck dissection in patients with advanced pyriform sinus carcinoma before combined chemoradiation in an organ preservation strategy. In our study, planned neck dissections were performed in patients with advanced laryngeal and hypopharyngeal carcinoma before combined chemoradiation in an organ preservation regimen.…”

“…Prades et al [2] performed a pretreatment planned neck dissection regardless of the N status before chemoradiation in an organ preservation setting. As a complete response might be achieved after chemoradiotherapy in most patients with N0 or N1 disease and the advantage of neck dissection is more controversial in these patients, only patients with N2 or N3 disease from SCC of the larynx or hypopharynx were treated with pretreatment neck dissection before chemoradiation in our series.…”

“…The 5-year overall survival rate and disease-specific survival rate in group A was Several studies [10][11][12] have confirmed that the use of preoperative radiation increases the risk of delayed wound healing and complications, especially if surgery is performed within 6 months to 1 year of the cessation of therapy. In an attempt to decrease the risk of delayed wound healing and complications and to get better neck node control, Prades et al [2] employed planned neck dissection in patients with advanced pyriform sinus carcinoma before combined chemoradiation in an organ preservation strategy.…”

“…In recent years, concurrent chemoradiotherapy as an alternative to primary surgery has become a widely accepted treatment for organ preservation in selected patients with advanced head and neck cancer [1] . As cervical metastasis is generally less responsive than the primary tumor [2] , planned or salvage neck dissection after chemoradiation for advanced head and neck carcinoma has been brought into the protocol of organ preservation [3][4][5][6][7][8] . Thirty-five percent of neck dissection specimens after chemoradiotherapy harbor microscopic residual tumor [9] .…”