Definitive Chemoradiation Without Planned Neck Dissection in Head and Neck Cancer

Introduction: Definitive concurrent chemoradiation in-creases 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 3.14- 470.24). Conclusion: For patients who have post definitive chemo-radiotherapy nodes of 1.5 cm or less without necrosis, follow-up without immediate neck dissection could be considered, especially in early T stage patients. These findings need large prospective randomized trials to be confirmed.