Superselective neck dissection after chemoradiation -: Feasibility based on clinical and pathologic comparisons

Objective: To determine whether superselective neck dissection (removal of 2 or less contiguous neck levels) is effective salvage surgery for patients with residual single-level adenopathy after concomitant intra-arterial cisplatin and radiotherapy. Design: Analysis of prospectively collected data. Subjects: The study group comprised 177 patients (239 heminecks) with N+ disease. Interventions: Intra-arterial treatment with cisplatin (150 mg/m(2)) on days 1, 8, 15, and 22 and radiation therapy (2 Gy/d) 5 times per week for 7 weeks. Comparisons were made between neck-level-specific disease at restaging and pathologic disease after neck dissection. Results: Tumor sites included oropharynx (n = 81), hypopharynx (39), larynx (n = 27), oral cavity (n = 19), and other (n = 11). Response of nodal disease based on clinical evaluation was as follows: complete response, 89 patients (50%); partial response, 81 patients (46%); progressive disease, 4 patients (2%); and unevaluable, 3 patients (2%). Of the 89 patients whose necks were re-staged as a partial response, 73 had clinical evidence of residual adenopathy involving only 1 neck level. Within this subset, 54 patients (57 heminecks) subsequently underwent a salvage neck dissection, for which comparisons were made between the restaging evidence of residual adenopathy and the pathologic findings that were specific for each neck level. Only 2 of the 54 patients had evidence of pathologic disease extending beyond the single neck level: one had disease in a contiguous neck level, and the other had disease in a noncontiguous level. The use of superselective neck dissection with removal of only 2 contiguous neck levels would have encompassed known disease in all but 1 patient. Conclusion: Superselective neck dissection is feasible after this specific chemoradiation protocol has been administered to patients with persistent nodal disease that is confined to 1 level.