Management of the clinically positive neck in organ preservation for advanced head and neck cancer

Paul Dagum, Harlan A. Pinto, James P. Newman, John P. Higgins, David J Terris, Don R. Goffinet, Willard E. Fee

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23 Scopus citations

Abstract

BACKGROUND: To investigate clinicopathologic predictive criteria for the optimal management of neck metastases in patients with advanced head and neck cancers treated with combined chemoradiotherapy. METHODS: Prospective study, 48 patients. Mean length follow-up, 23 months. RESULTS: Neck stage predicted neck response to chemoradiotherapy; N3 necks showed more partial responses (P = 0.04), and N1 necks showed more complete responses (P = 0.12). Primary tumor site strongly predicted the pathologic response found on neck dissection in patients with a clinical partial response (cPR) following chemoradiotherapy. There was no difference in survival between patients with a clinical complete response (cCR) after chemoradiotherapy, and patients with a pathologic complete response (pCR) after neck dissection (P = 0.20); however, when grouped together, these patients survived longer than did patients with a pPR at neck dissection (P = 0.06). CONCLUSIONS: Clinical response to induction chemotherapy is a poor predictor of ultimate neck control. Induction chemotherapy followed by chemoradiotherapy, and planned neck dissection for patients with persistent cervical lymphadenopathy, provides good regional control.

Original languageEnglish (US)
Pages (from-to)448-452
Number of pages5
JournalAmerican Journal of Surgery
Volume176
Issue number5
DOIs
Publication statusPublished - Nov 1 1998
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery

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