Definitive Chemoradiation Without Planned Neck Dissection in Head and Neck Cancer

Introduction: Definitive concurrent chemoradiation increases locoregional control and organ preservation in head and neck cancer. The ultimate benefit of planned neck dissection after completion of this treatment is questionable. Patients and Methods: The medical records of 53 head and neck cancer patients treated by definitive chemoradiation and no planned neck dissection were reviewed. Patients who have post-treatment lymph nodes of 1.5cm or less without necrosis were to be followed-up, while patients who didn't have these criteria were to have neck dissection. Results: Thirty-two patients were followed up without neck dissection. The 3-year RFS and OS of this group was 80% and 87% respectively. By univariate analysis N stage and T stage were prognostic factors for RFS. By multivariate analysis, however, only T-stage was an independent prognostic factor for RFS (p=.004), hazard ratio 38.48 (95% CI 3.14470.24). Conclusion: For patients who have post definitive chemoradiotherapy nodes of 1.5 cm or less without necrosis, followup without immediate neck dissection could be considered, especially in early T stage patients. These findings need large prospective randomized trials to be confirmed.