Neck dissection followed by radiotherapy or chemoradiotherapy for small primary oropharynx carcinoma with cervical metastasis

Objectives: A cohort of patients with small primary (T1-T2) squamous cell carcinoma of the oropharynx and advanced cervical nodal metastasis were treated with initial neck dissection(s) followed by definitive radiation therapy with or without chemotherapy. Our rationale for this algorithm and our results are examined. Study Design: Retrospective chart review. Methods: Pathology records and medical records from 1996 to 2003 from the Johns Hopkins Hospital were examined for patients meeting the inclusion criteria. Results: Sixteen patients meeting the inclusion criteria were identified. Follow-up periods ranged from 6 to 75 months. Mean and median follow-up periods were 38 and 33 months, respectively. One (6.25%) patient developed a metastasis and was alive with disease at last follow-up. Fifteen (93.75%) patients were alive without evidence of disease at last follow-up. Overall survival was 100%. Disease free survival was 93.75%. Conclusion: Initial neck dissection followed by primary radiation therapy to the primary site and neck with or without chemotherapy is an effective therapy for small primary oropharynx cancers with N2 or greater cervical metastases.