MANAGEMENT OF THE NECK IN PATIENTS WITH HEAD AND NECK-CANCER TREATED BY CONCURRENT CHEMOTHERAPY AND RADIATION

The current high level of interest in organ preservation strategies fo r patients with advanced squamous cell carcinoma of the head and neck undoubtedly will result in increasing numbers of patients managed init ially with chemotherapy and radiation, either sequentially or concurre ntly. In some protocols, surgery, and neck dissection in particular, w ill either be mandatory or offered based on the degree of response to treatment and initial stage of neck disease. Head and neck oncologic s urgeons need to be involved and at the forefront of such trials, to al low meaningful data regarding pathologic response to treatment to be o btained, as well as to define the role of surgery in such patients. Al though present data is limited, it would appear that in patients achie ving a complete response to chemoradiation, the role of neck dissectio n may be more limited than in the past, even for patients with N2 to N 3 neck disease at presentation. Surgical complications may be increase d in this heavily treated patient population, and subsequent surgery s hould be designed to minimize the risk of wound complications, especia lly if performed before the patient has made a full recovery from the metabolic and immunologic derangements associated with chemoradiation. Head and neck surgeons need to play an active role in the design and conduct of chemoradiation trials so that these and other relevant ques tions will be answered by the data generated.