Planned postradiotherapy neck dissection in patients with advanced head and neck cancer

The role of initial neck dissection for patients with node-positive oropharyngeal squamous cell carcinomas

“…Neck dissection (ND) is most likely to be performed when primary disease is treated surgically for patients with regional metastasis. Traditionally, most patients with N2 or N3 disease have generally undergone initial ND consisting of upfront ND followed by concomitant chemoradiotherapy (CRT) or radiotherapy (RT), and planned ND regardless of nodal response [3,4]. However, in recent years, some investigators have advocated observation of the neck in patients initially diagnosed with N2-N3 disease, provided a complete response (CR) of regional disease is achieved after CRT or RT [5][6][7].…”

Lymph node‐positive head and neck cancer treated with definitive radiotherapy

“…All patients with N2 and N3 disease had planned neck dissections; patients with N1 disease underwent neck dissection for residual adenopathy only. By correlating the neck dissection pathology to the post-RT CT reading by neck level, they demonstrated that the false-negative rate of the post-RT CT was negligible for levels I and V, and concluded that post-RT neck dissections could be safely limited to levels II through IV in the absence of radiologic evidence of residual disease in levels I and V. Boyd et al 20 reviewed the neck dissection pathology of 25 patients with lymph node-positive squamous cell carcinoma of the head and neck who were treated with definitive RT and planned neck dissection. Only 1 of 28 neck dissection specimens revealed tumor outside of levels II through IV.…”

Clinical Utility of18F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

“…Early studies (1-3) comparing radiation alone with radiation followed by neck dissection demonstrated superior results with combined radiation and neck dissection, leading to the practice of planned neck dissections for patients with N2-N3 disease on presentation-regardless of the response to treatment-as well as for patients with N1 disease and clinical evidence of persistent palpable lymph nodes after irradiation (4)(5)(6). However, concurrent chemoradiotherapy is now increasingly applied as the definitive treatment of choice for locoregional advanced HNSCC (7)(8)(9).…”