Management of the neck after alternating chemoradiotherapy for advanced head and neck cancer

Background. To investigate neck control probability and the value of nodal response at completion of alternating chemoradiotherapy, a group of 43 pati ents was reviewed. Methods. Patients were treated with 60 Gy alternated with four cycles of ci splatin and fluorouracil. All patients had lymph nodes positive for squamou s cell carcinoma from various primary sites, underwent computed tomography (CT) for staging and evaluation of response, and were treated at a single i nstitution. Patients with bilateral lymph nodes (N2c) were further staged a ccording to the side of dominant neck disease. Results. After chemoradiotherapy alone, 2-year neck control probabilities ( NCP) are 86 +/- 13%, 58 +/- 10%, and 0 for N1, N2a/b, and N3 neck stages, r espectively (p =.038). Two-year NCP for 25 complete responders is 85 +/- 8% , whereas, at the same time interval, it is 17 +/- 9% for 18 partial respon ses (p <.0001). Within patients with N1-2a/b neck disease, 21 complete resp onders had a 2-year NCP of 92 +/- 8%. Five (11%) heminecks in four patients developed severe (Radiation Therapy Oncology Group [RTOG] grade > 2) subcu taneous late reactions. Conclusions. For patients with N1-2a/b neck disease, response at the end of treatment as evaluated by both physical exam and CT is a reliable criterio n to select patients for complementary surgery even after chemoradiotherapy . For N3 disease, planned neck dissection regardless of response seems warr anted. (C) 1999 John Wiley & Sons, Inc.