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Role of Neck Dissection in Locoregionally Advanced Head and Neck Cancer Treated with Primary Chemoradiotherapy

Martin M,García J *,Lopez M,Hinojar A,Manzanares R,Fernandez L ,Prada J ,Cerezo L

1.1. Introduction: Planned neck dissection after chemoradiotherapy (CRT) in locoregionally advanced head and neck cancer is controversial. The objective of the present study was to evaluate the influence of neck dissection on the long-term locoregional control and survival of patients with stage III-IV head and neck squamous cell carcinoma (HNSCC) after primary CRT.
1.2. Methods/Patients: We retrospectively analysed locoregional control, locoregional relapse-free survival (LRFS), and overall survival (OS) in 67 patients with locally-advanced HNSCC treated with exclusive CRT at our department between January 1998 and December 2013.
1.3. Results: Complete clinical response was achieved in 36 of 67 patients (53.7%), partial response > 50% in 17 pts (25.4%), stable disease in 3 (4.5%); 9 patients (13.4%) developed disease progression during treatment. At a median follow-up of 35 months, LRFS and OS were 100% in patients with complete response and neck dissection versus 77.9% and 79.8%, respectively, in patients who did not undergo neck dissection (p = ns). The only independent prognostic factor for locoregional control was complete response to CRT.
1.4. Conclusions: Patients who achieve a complete clinical response to CRT have a very low risk of isolated neck recurrence and, therefore, planned neck dissection may not be justified in such cases. Clinical and radiographic identification of patients with residual disease following CRT who could benefit from neck dissection remains challenging.