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.
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.
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).
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: firstname.lastname@example.org.