Objective: Neck dissection remains the standard m thod of treating cervical m e tastasis from head and n eck squamous cell carcinoma. In light of recent trends to modify the classic radical neck dissection (RND) for early n ck di a e, we reviewed our experience with r a dfoal and modified RND (MR.ND) plus radiotherapy as ti·ea tment for N2/N3 neck di sease in h ead and n ck squamous cell carcinoma. Methods: We r trosp ective ly r eviewed our clinical r ecords from July 1989 to Jun 1996 to identify 43 neck dissections in 39 p a tie nt who were found to h ave pathologically N2 or N3 n eck disea se tr ated primarily by neck di section and postoperative radiotherapy. All patients had h ead and n eck squamous cell carcinoma with a minimwn follow-up of 24 months. R esults: Nine p ercent (4143) of the di ssected n ecks were pathologically N2a, 72% (31/43) were N2b, 7% (3143) were N2c, and 12% (5/43) wer N3. Of these, 28% (12/43) underwent a RND and 72% (31/43) underwent a MRND. The most common modification of RND was preservation of the spinal accessory n erve. All p a tients underwent postop rative radiotherapy with a m ean dose of 55 Gy. Only 4 of 43 di s cted n ecks had isolate d treatment failure , for a regional control rate of91%. Conclusions: The combination of RND or MRND and radiotherapy is highly effi c tive in controlling n eck disease in the a bsence of persiste nt or r ecurre nt local disease. Also, in our exp rience, MR.ND appears to be as effective as RND in controlling ev n advanced n eck disea se, which upports preservation of the s pinal accessory n erve when ver oncologica lly feasible.
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