Role and extent of neck dissection for persistent nodal disease following chemo-radiotherapy for locally advanced head and neck cancer: How much is enough?

Figures & data

Table I.  Patient characteristics

Age in years Median (range)	53.5 (37–79)
Sex
Male	39
Female	3
Site
Oropharynx	31
Larynx	5
Hypopharynx	3
Nasopharynx	1
Unknown Primary	2
N Stage
N1	2
N2	26
N3	14

Table II.  Clinical Characteristics of Pathologically Positive versus Pathologically Negative Patients.

	Node−(n = 31)	Node+(n = 11)	p-value *
Pre-treatment Nodal Size (cm)
Median	4.5	5	0.71
Range	(2.5–9)	(2.5–9)
T Stage
T1, T2	17	6	0.72
T3, T4	13	4
Tx	1	1
N Stage
N1	2	0	0.9
N2	19	7
N3	10	4
No. Nodes Removed
Median	15	12	0.21
Range	(5–43)	(7–67)

* The p-values are from Wilcoxon Rank Sum Test for the comparisons of continuous variables, and Fisher's Exact Test for the comparisons of categorical variables.

Table III.  Treatment characteristics of Pathologically Positive versus Pathologically Negative Patients.

	Node−(n = 31)	Node+(n = 11)
Dose (Gy)
Median	70.4	70.4
Range	(70–71)	(68–71)
Elapsed Treatment Time (days)
Median	54	54
Range	(47–79)	(47–63)
Days between XRT and Neck Dissection
Median	58	61
Range	(27–119)	(35–87)

Table IV.  Percentage According to Sites Involved for Pathologically Node Positive versus Node Negative Patients

	Node −	Node +
Oropharynx	80% (25)	20% (6)
Larynx / Hypopharynx	50% (4)	50% (4)
Nasopharynx	100% (1)
Unknown Primary	50% (1)	50% (1)

*p-value is 0.204 from Fisher's Exact Test

Figure 1.  The clinical and pathological nodal level(s) involved in patients with positive neck dissections revealing pathologic positively always within the clinically involved nodes.

Figure 2.  The suggested possible schema for a trial to optimize the use of imaging modalities for selecting patients for surgical intervention. The recommended design of the trial will test if gross nodal dissection (could also be termed as “supra selective ND”) has similar outcome as standard ND in terms of treatment efficacy with reduced mobility.