Upfront radical neck dissection in patients cN2-3

Abstract

Introduction: The standard treatment of patients with metastatic squamous cell carcinoma at loco-regionally advanced stage is the association of radiation-chemotherapy; however, a high percentage of these persist and require rescue surgery, which implies significant morbidity. Initial neck dissection could play an important role in reducing this rate of complications. Objective: To know oncological results of patients with neck metastasis. Materials and methods: Retrospective analysis of patients undergoing treatment for cervical lymph node metastasis of squamous cell carcinoma. The therapeutic sequence was decided based on volume, resectability, site and size of the primary and general condition of the patient. Overall survival was calculated based on HPV status. Results: We included 30 patients with a mean age of 57 years and a mean follow-up of 5 years: 22 men and 8 women. All with loco-regionally advanced stages, 10 N3 and 20 N2. In 18, determination of p16 was made in the lymph node metastases, in 13 of them it was positive and in 5, negative. Seven patients were treated with initial chemotherapy and 23 underwent neck dissection; 5-year survival was 25% and the prognosis was better in patient with positive p16. Conclusion: The treatment of cervical metastasis depends on its resectability; initial surgery should be promoted. Neo-adjuvant chemotherapy is an alternative in patients with bulky, unresectable or borderline metastases, HPV is a factor of good prognosis.