SALVAGE NECK DISSECTION FOR CERVICAL RECURRENCE OF NASOPHARYNGEAL CARCINOMA

Objective: To evaluate the effectiveness of salvage neck dissection as part of a multidisciplinary treatment approach in persistent or recur rent metastatic nasopharyngeal carcinoma, after failure of initial rad iotherapy at the regional site. Design: A retrospective study of 31 pa tients treated during a 14-year period from March 1981 through May 199 5, with a maximum follow-up of 152 months. Factors evaluated include p atients' sex, age, and initial stage of tumor, mobility and number of nodal recurrences, surgical and pathological findings, and postoperati ve irradiation. Setting: Academic tertiary referral center. Patients: Twenty-six men and 5 women were studied; one patient had neck dissecti on to both sides of the neck on separate occasions, for a total of 32 operations. All patients had pathologically proved nasopharyngeal carc inoma and had been previously treated at the primary site and both sid es of the neck with definitive radiotherapy. Intervention: Patients un derwent a radical, modified radical, or level I-sparing radical neck d issection. Main Outcome Measure: Surgical morbidity, time to recurrenc e at the regional site, and survival time. Results: Clinically, there was a disease predilection of 81% at levels II and V. Surgical morbidi ty was minimal. Regional control was achieved in 20 (65%) of the patie nts, and the overall 5-year survival was 67%. Tumor involvement of the posterior triangle musculature and spinal accessory nerve was associa ted with failure to control neck disease. Extracapsular nodal extensio n correlated with a poor survival outcome. Conclusion: Control of regi onal disease by salvage neck dissection when radiotherapy has failed i s both safe and effective in properly selected patients.