Radiotherapy followed by neck dissection for small head and neck cancers with advanced cervical metastases

Patients with small or occult primary carcinomas of the head and neck with advanced cervical metastases present a difficult problem for the otolaryngo logist. A retrospective review was performed of patients who presented to U CLA Medical Center between January 1986 and June 1996 with small or occult primary tumors of the head and neck with advanced cervical metastases. The treatment algorithm consisted of initial radiotherapy to the primary site a nd the neck, followed in 6 to 8 weeks with endoscopy and biopsy of the prim ary tumor site. As long as the repeat biopsy of the primary tumor sire was negative by frozen section, an immediate neck dissection was performed, eve n if no residual neck disease was present. Almost 40% of patients with no c linical evidence of neck disease following radiotherapy had evidence of met astatic cancer on histopathologic examination. While some would consider a watchful waiting policy when there is no clinically detectable neck disease following radiotherapy, we believe it is preferable to perform immediate s urgery in such patients, in light of the high incidence of microscopic meta static disease.