Persistent neck disease after chemoradiation for head and neck squamous cell carcinoma

Objective: This study aimed to identify the incidence of residual viable neck disease in patients with mucosal squamous cell carcinoma of the upper aero-digestive tract, following primary chemoradiation at a tertiary centre. Study design: Retrospective review. Methods: Retrospective chart review of patients treated with primary chemoradiation for squamous cell carcinoma of the aero-digestive tract between August 2001 and August 2008. Neck status pre- and post-treatment was the primary focus. Results: Forty-two patients with node-positive disease prior to chemoradiation were included. Thirty-seven (88.1 per cent) achieved complete response to treatment: no patient in this group underwent neck dissection, five died due to recurrence at the primary site or distant metastasis, and none suffered neck recurrence. Five (11.9 per cent) patients achieved partial response to chemoradiation and underwent neck dissection; viable tumour was found in one patient. Conclusion: Our data support conservative management of the neck in patients with complete response to chemoradiation, and consolidation neck dissection in patients with partial response.