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Am J Surg. 1998 Nov;176(5):448-52.

Management of the clinically positive neck in organ preservation for advanced head and neck cancer.

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1
Division of Otolaryngology/Head and Neck Surgery, Stanford University School of Medicine, California 94305-5407, USA.

Abstract

BACKGROUND:

To investigate clinicopathologic predictive criteria for the optimal management of neck metastases in patients with advanced head and neck cancers treated with combined chemoradiotherapy.

METHODS:

Prospective study, 48 patients. Mean length follow-up, 23 months.

RESULTS:

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).

CONCLUSIONS:

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.

PMID:
9874431
[Indexed for MEDLINE]
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