Management of the clinically positive neck in organ preservation for advanced head and neck cancer 44th Annual Meeting of the Society-of-Head-and-Neck-Surgeons Dagum, P., Pinto, H. A., Newman, J. P., Higgins, J. P., Terris, D. J., Goffinet, D. R., Fee, W. E. EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. 1998: 448–52


To investigate clinicopathologic predictive criteria for the optimal management of neck metastases in patients with advanced head and neck cancers treated with combined chemoradiotherapy.Prospective study, 48 patients. Mean length follow-up, 23 months.Neck stage predicted neck response to chemoradiotherapy; N3 necks showed more partial responses (P = 0.04), and N1 necks showed more complete responses (P = 0.12). Primary tumor site strongly predicted the pathologic response found on neck dissection in patients with a clinical partial response (cPR) following chemoradiotherapy. There was no difference in survival between patients with a clinical complete response (cCR) after chemoradiotherapy, and patients with a pathologic complete response (pCR) after neck dissection (P = 0.20); however, when grouped together, these patients survived longer than did patients with a pPR at neck dissection (P = 0.06).Clinical response to induction chemotherapy is a poor predictor of ultimate neck control. Induction chemotherapy followed by chemoradiotherapy, and planned neck dissection for patients with persistent cervical lymphadenopathy, provides good regional control.

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