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Incidence of Nodal Disease After Nonsurgical Therapy in Head and Neck Squamous Cell Carcinoma Patients With Bilateral Neck Disease: Can a Bilateral Neck Dissection be Avoided?

Fried, David BS*; Weissler, Mark MD†,‡; Shores, Carol MD, PhD†,‡; Couch, Marion MD†,‡; Hayes, Neil MD, MPH‡,§; Hackman, Trevor MD†,‡; Zanation, Adam MD; Qaqish, Bahjat PhD‡,∥; Chera, Bhishamjit S. MD*,‡

American Journal of Clinical Oncology: April 2013 - Volume 36 - Issue 2 - p 188–191
doi: 10.1097/COC.0b013e3182436eda
Original Article: Head & Neck
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Background: We evaluated whether classifying 1 side of a patients’ neck as “high risk” would help in deciding the extent of neck dissection in patients with bilateral nodal disease.

Methods: We conducted a retrospective review of 44 patients (88 heminecks) with head and neck squamous cell carcinoma who had bilateral nodal disease and received definitive chemoradiotherapy (CRT). For lateralized lesions (70%), the ipsilateral neck was designated as the “high-risk” neck. For midline lesions, pre-CRT and post-CRT computed tomography scans were used to stage each side of the neck (hemineck); the higher staged hemineck was designated as the “high-risk” neck.

Results: Twenty-seven patients had died at the time of analysis. Patients had a median follow-up of 27.8 months (range, 6 to 150 mo). Two-year neck control and overall survival were 83% and 56%, respectively. Sixty-two heminecks (71%) were dissected. A total of 6/22 (27%) “low-risk” necks were positive after CRT if the “high-risk” neck was positive versus 0/22 if the “high-risk” neck was negative (P=0.02).

Conclusions: Identifying the more “high-risk” neck may be useful when deciding the extent of neck dissection after CRT. For patients with bilateral nodal disease treated with CRT, dissection of the “low-risk” hemineck may be omitted if the “high-risk” neck is pathologically negative.

*Department of Radiation Oncology

Department of Otolaryngology

Lineberger Comprehensive Cancer Center

§Department of Medicine, Division of Hematology/Oncology

Department of Biostatistics, University of North Carolina, Chapel Hill, NC

The authors declare no conflicts of interest.

Reprints: Bhishamjit S. Chera, MD, Department of Radiation Oncology, UNC Hospitals, Room 1043, NC Clinical Cancer Center, 101 Manning Drive, Chapel Hill, NC 27514. E-mail: bchera@med.unc.edu.

© 2013 by Lippincott Williams & Wilkins, Inc