A conservation approach to pharyngeal carcinoma with advanced neck disease: Optimizing neck management

Background. Surgical management of advanced neck disease remains controvers ial when a conservative approach based on radiotherapy is retained for prim ary tumors. The objective of this study was to evaluate retrospectively tre atment results in pharyngeal cancers presenting with N2-N3 neck disease, us ing neck dissection followed by radical locoregional radiotherapy (RT) and to compare these results with those obtained in patients treated by radical RT alone. Methods. From August 1991 to November 1996, 41 patients with carcinomas of the oro- or hypopharynx were staged as T1-T3 N2-N3 MO (American Joint Commi ttee on Cancer [AJCC] stage IV). Twenty-four patients were treated with nec k dissection followed by RT (group 1)and 17 patients with radical RT (group 2) using a progressively accelerated concomitant boost schedule. Chemother apy was delivered to 6 patients in group 1 and 8 in group 2 partially conco mitantly with RT. Results. Three-year actuarial locoregional control was 73% and 55% for grou ps 1 and 2, respectively (p =.52). The corresponding 3-year actuarial overa ll survival rates were 37% and 50% (p=.42). Severe postoperative complicati ons were observed after neck dissection in four patients (16%). Acute toxic ity during Ri was similar in the two groups. Late toxicities were also simi lar, except for two patients in group 1 who developed severe laryngeal edem a. Conclusions. Neck dissection followed by radical RT to the primary tumor an d neck represents a valid treatment option in this subset of patients. allo wing good control of advanced neck disease, while at the same time conservi ng pharyngolaryngeal function. However, for patients who are at high risk o f severe postoperative complications, radical RT can be considered a worthy alternative, particularly for oropharyngeal carcinomas. (C) 1999 John Wile y & Sons, Inc.