Treatment Options: Study reports neck dissection effective in patients with residual disease

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February 2011

The study involved 230 patients treated for head and neck squamous cell carcinoma.

SCOTTSDALE—Patients who had residual neck disease after treatment for a primary head and neck squamous carcinoma and then underwent neck dissection had comparable survival rates to those who had their disease resolved after their initial chemotherapy and radiation treatment, according to a retrospective analysis from researchers at the University of Louisville in Kentucky presented here Jan. 27.

The study, presented at the Triological Society’s Combined Sections Meeting, provides evidence that neck dissection plays an important role when dealing with residual disease in patients who have been treated for head and neck malignancies.

“In the age of chemotherapy and irradiation for definitive head and neck squamous cell carcinoma, the most effective treatment of the neck has not been well characterized,” said Laura Dooley, MD, a third-year resident in Louisville’s surgery department, who worked with Keven Potts, MD, and Jeffrey Bumpous, MD, both of Louisville’s department of surgery. “The literature describes variances in treatment of residual neck disease that range from mandatory neck dissection to the selective use of neck dissection based on imaging studies after treatment such as PET or CT scans.”

Findings

The study involved 230 patients treated for head and neck squamous cell carcinoma at the James Graham Brown Cancer Center in Louisville, Ky. between 2005 and 2009.

Fifty-eight percent, 133 patients, were complete responders, in that they had no evidence of residual disease after their initial treatment. Another 23 patients, or 10 percent, still had residual primary site disease and needed more treatment. The remaining 74, the patients on whom the study focused, had residual neck disease after treatment.

Researchers set out to learn how many of those patients still had malignancies, and how those who needed dissection fared compared to the others.

“It is the practice at our institution to perform neck dissections on those patients who do not achieve a complete response in the neck,” Dr. Dooley said. “It was the goal of this study to see how many of the patients who underwent neck dissection for residual neck findings after therapy actually had a positive pathology report. Were these masses residual malignancy, or were they simply fibrosis?”

Patients who had started treatment for malignancies but hadn’t completed treatment, along with those without adequate follow-up, were excluded from the study.

Those who were found to have residual neck disease after their initial treatment had a PET scan or a CT with contrast within 12 weeks. In 35 of the patients, roughly half of those studied, the disease had resolved by that time. The other 39 still had residually positive neck disease and underwent neck dissections at four months.