The management of the neck in NPC is a challenging endeavor. External beam radiotherapy occupies a central position in the treatment paradigm for primary therapy. For recurrent or persistent neck disease, radical neck dissection has gained acceptability over reirradiation at several treatment centers around the world. Previously held contraindications to neck dissection, such as persistence of disease at the primary site, is becoming passe, because resection of the primary can now be done safely in selected patients. Primary surgical therapy, however, has not gained much acceptance, even in the keratinizing form of NPC or the large N stages that show some diminution of sensitivity to RT. There is a strong correlation between extent of disease at the neck (N stage) and tendency to distant metastasis, an area in which all varieties of therapy have failed significantly. Future advances should attempt to standardize the staging criteria, and emphasize new innovative diagnostic and therapeutic regimens to address the systemic component.
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