Management of Cervical Metastases in Advanced Squamous Cell Carcinoma of the Tonsillar Fossa Following Radiotherapy

Abstract

To assess the value of planned neck dissection in patients with a complete response to definitive radiotherapy for squamous cell carcinoma of the tonsillar fossa with advanced nodal disease. Design: Case series. Setting: Academic tertiary care medical center. Patients: A consecutive series of 36 patients with squamous cell carcinoma of the tonsillar fossa with N2 or N3 nodal disease treated with primary radiation therapy with or without concurrent chemotherapy between January 1, 1992, and April 1, 2003, at the University of California, San Francisco, Comprehensive Cancer Center. Patients treated with primary surgery, those treated with palliative intent, or those with preexisting malignancies were excluded. Main Outcome Measures: Regional control and overall survival. Results: Of the study group, 15 patients (42%) achieved a complete response, 17 (47%) achieved a partial response, and 1 (3%) was a nonresponder. The response in 3 patients (8%) could not be assessed. Of the 15 patients with a complete response, only 2 (13%) later developed regional recurrences, 1 of which was an isolated recurrence in the neck. Regional control and overall survival at 3 years were 78% and 48%, respectively. Conclusions: The rate of regional recurrence after a complete response to radiation therapy with or without concurrent chemotherapy for tonsillar squamous cell carcinoma with advanced cervical metastases is low. Our results support close surveillance of the neck in those who have achieved a complete response after radiation therapy with or without chemotherapy.

Robotic‐assisted FAMM flap for soft palate reconstruction

“…Only 2 of these 14 dissected patients were found to have evidence of residual tumor in their neck‐dissection specimens. Two other reports from our institution have also addressed this issue 39, 40. Recent reports suggest that 18FDG‐PET scan may be useful for selected patients who may benefit from a neck dissection after radiation therapy.…”

Intensity‐modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma

“…Two other reports from our institution have also addressed this issue. 39,40 Recent reports suggest that 18FDG-PET scan may be useful for selected patients who may benefit from a neck dissection after radiation therapy. Yao et al showed that for patients with residual lymphadenopathy and a negative PET scan at 12 weeks after definitive radiation treatment, neck dissection can be safely withheld, 41 with a negative predictive value of 100% and a positive predictive value of 43%.…”

Clinical outcome following radiotherapy and planned neck dissection in N+ head and neck cancer patients

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