N2-N3 neck nodal control without planned neck dissection for clinical/radiologic complete responders - Results of Trans Tasman Radiation Oncology Group study 98.02

Background. The aim of this study was to determine the incidence of isolated nodal failure in patients with N2/3 disease who achieved a complete clinical and radiological response (CR) at 12 weeks postchemoradiation, when no planned neck dissection was performed. Methods. We analyzed the nodal response and subsequent neck control of 102 patients with initial N2/3 disease treated on the Trans Tasman Radiation Oncology Group 98.02 study. Results. With a median 4.3 years follow-up, the patterns of first failure in the CR patients were local 4%, local and nodal 2%, distant 28%, and locoregional plus distant (within 1 month) 6%. There were no patients who had only neck failure. Conclusion. Patients in this trial with N2/3 disease who obtained a clinical and radiological complete response to chemoradiation had a zero incidence of isolated neck failure without a planned neck dissection. The continued use of planned neck dissections in this patient subset cannot be justified. (C) 2008 Wiley Periodicals, Inc.