Planned neck dissection following chemoradiotherapy for advanced head and neck cancer: Is it necessary for all?

Phillip K. Pellitteri, Alfio Ferlito, Alessandra Rinaldo, Jatin P. Shah, Randal S. Weber, John Lowry, Jesus E. Medina, Christine Gourin, K. Thomas Robbins, Carlos Suárez, Ashok R. Shaha, Eric M. Genden, C. René Leemans, Jean Louis Lefebvre, Luiz P. Kowalski, William I. Wel

Research output: Contribution to journalArticle

Abstract

In the absence of large-scale randomized trials evaluating dissection versus observation of the involved neck after neoadjuvant chemoradiotherapy, there is a need to collect data that will either support or ultimately refute a role for planned posttreatment neck dissection. A significant percentage of patients with extensive (N2 or N3) neck disease who demonstrate a complete response to chemoradiation therapy may harbor residual occult metastases, and identification of this subset of patients remains a clinical challenge. Because surgical salvage rates are greatly diminished when occult nodal disease becomes clinically manifest, planned posttreatment neck dissection is advocated but may not be necessary in all patients. The role of positron emission tomography chemoradiotherapy (PET-CT) in this scenario remains unproven but holds promise in being able to identify which patients may be harboring residual disease in the neck after chemoradiotherapy. The implementation of as yet unidentified molecular tumor markers in combination with PET-CT may ultimately prove to be effective in identifying patients who will best benefit from posttherapy neck dissection. Correlation of imaging results and pathologic node status will be important in determining the accuracy and, therefore, the value of this imaging modality for predicting the presence or absence of residual disease.

Original languageEnglish (US)
Pages (from-to)166-175
Number of pages10
JournalHead and Neck
Volume28
Issue number2
DOIs
Publication statusPublished - Feb 2006
Externally publishedYes

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Keywords

  • Advanced head and neck cancer
  • Cervical metastasis
  • Chemoradiotherapy
  • Planned neck dissection
  • Squamous cell carcinoma

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Pellitteri, P. K., Ferlito, A., Rinaldo, A., Shah, J. P., Weber, R. S., Lowry, J., ... Wel, W. I. (2006). Planned neck dissection following chemoradiotherapy for advanced head and neck cancer: Is it necessary for all? Head and Neck, 28(2), 166-175. https://doi.org/10.1002/hed.20302