11:14 AM: Response of Neck Metastases to Chemoradiation

Abstract

OBJECTIVE: 1. To analyze the response of neck disease to treatment with primary chemoradiation. 2. To determine when neck dissection should be done following chemoradiation. METHODS: Retrospective review of patients with head and neck cancer (HNSCC) treated with chemoradiation with curative intent at a Veterans' Administration hospital, with specific attention given to the response of the neck disease to the treatment. RESULTS: Thirty-two patients were identified who received concomitant chemotherapy and radiation: 8 patients with N1, 19 with N2, and 5 with N3 disease; 63% of patients had complete clinical and radiographic response of their neck disease following treatment. One additional patient had radiographic evidence of neck disease post-treatment that continued to diminish in size on subsequent CT scans over the following year. Eleven patients underwent neck dissection post-treatment (two patients with N1, six patients with N2, and three patients with N3 disease); 36% of the neck specimens had pathologically positive nodes. One of the N1, 2 of the N2, and one of the N3 neck dissections had positive nodes. Two patients who had complete clinical and radiographic response in the neck went on to recur at their primary site and die of their disease. Seventy-eight percent of patients were alive without evidence of recurrent disease in the primary site or neck at last followup. CONCLUSIONS: The majority of HNSCC patients treated with chemoradiation have complete response in the neck. Patients with clinical and radiographic evidence of complete response in the neck may not require neck dissection, even with N2 or greater disease.