PLANNED EARLY NECK DISSECTION BEFORE RADIATION FOR PERSISTENT NECK NODES AFTER INDUCTION CHEMOTHERAPY

Optimal management of advanced neck metastases as part of an organ pre servation treatment approach for head and neck squamous carcinoma (HNS C) is unclear. Since 1989, our management paradigm for patients on org an preservation was modified to incorporate planned early neck dissect ion before radiation therapy for patients who did not achieve a comple te response (CR) of neck nodes after induction chemotherapy (IC). The purpose of this study was to determine if planned early neck dissectio n is a safe and effective approach in the management of advanced nodal disease as part of organ preservation. Fifty-eight consecutive patien ts with advanced HNSC who were entered in organ preservation trials us ing induction chemotherapy and radiation with surgical salvage were st udied. Median follow-up was 26 months. Of the 58 patients, 71% were st age IV. Patients were grouped by nodal response to chemotherapy and N class, and were analyzed with respect to patterns of recurrence, compl ications, and survival. Overall, the rate of CR of neck nodes was 48%. Fifty-one percent had less than a complete response of neck nodes aft er IC and required planned early neck dissection. There were no signif icant differences in patterns of recurrence, complications, interval t ime to start of radiation, recurrence, or survival rates between the C R and less than CR groups. These data suggest that planned early neck dissection for patients with less than CR in the neck after IC is not detrimental with respect to neck relapse or overall survival. We belie ve that planned early neck dissection can be safely incorporated into future organ preservation treatment protocols for patients with advanc ed head and neck carcinoma.