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

BACKGROUND: TO investigate clinicopathologic predictive criteria for the op timal 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), end 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 resp onse (cPR) following chemoradiotherapy. There was no difference in survival between patients with a clinical complete response (cCR) after chemoradiot herapy, and patients with a pathologic complete response (pCR) after neck d issection (P = 0.20); however, when grouped together, these patients surviv ed longer than did patients with a pPR at neck dissection (P = 0.06). CONCLUSIONS: Clinical response to induction chemotherapy is a poor predicto r of ultimate neck control. Induction chemotherapy followed by chemoradioth erapy, and planned neck dissection for patients with persistent cervical ly mphadenopathy, provides good regional control. Am J Surg. 1998;176:448-452. (C) 1998 by Excerpta Medica, Inc.