Efficacy of Targeted Chemoradiation and Planned Selective Neck Dissection to Control Bulky Nodal Disease in Advanced Head and Neck Cancer

• Published in: Archives of otolaryngology--head & neck surgery Vol. 125; no. 6; pp. 670 - 675
• Main Authors: Robbins, K. Thomas, Wong, Frank S. H, Kumar, Parvesh, Hartsell, William F, Vieira, Francisco, Mullins, Brent, Niell, H. Barry
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01-06-1999
• Subjects: Adult; Aged; Aged, 80 and over; Algorithms; Biological and medical sciences; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Combined Modality Therapy; Female; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Humans; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Neck Dissection; Neoplasm Staging; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Patient Care Planning; Remission Induction; Time Factors; Treatment Outcome; Tumors; Human; Squamous cell carcinoma; Prognosis; Lymph node; Selectivity; Malignant tumor; Metastasis; Radiotherapy; Chemotherapy; Surgery; Head and neck; ENT disease; Advanced stage; Combined treatment; Neck; Dissection
• ISSN: 0886-4470; 2168-6181; 1538-361X; 2168-619X
• DOI: 10.1001/archotol.125.6.670

PURPOSE To determine the efficacy of targeted chemoradiation with the radiation plus platinum (RADPLAT) protocol and planned selective neck dissection in patients with N2 to N3 nodal disease associated with upper aerodigestive tract carcinoma. METHODS Analysis of 52 patients with N2a, N2b, or N3 disease involving 60 heminecks treated with intra-arterial cisplatin, 150 mg/m2, and intravenous sodium thiosulfate, 9 g/m2, on days 1, 8, 15, and 22; radiation therapy, 180 to 200 cGy per fraction for 35 fractions (total dose, 68-74 Gy); and planned neck dissection (33 of 35 procedures were selective). RESULTS Of the 56 evaluable heminecks, a clinical complete response was achieved in 33 (59%). Within this group, 16 neck dissections were performed, none of which yielded disease on pathological examination. A clinical partial response was obtained in 21 heminecks, of which 18 subsequently had a neck dissection, yielding disease on pathological examination in 14. In all cases, it was possible to completely excise all adenopathy with clear margins on pathological examination. The rate of regional disease control among the 56 evaluable heminecks was 91% (51/56) (median follow-up, 36 months). Four failures were associated with uncontrolled disease at other sites, and 1 was an isolated neck recurrence. CONCLUSION Selective neck dissection appears to be an effective adjunct to targeted chemoradiation in controlling N2 to N3 neck disease.Arch Otolaryngol Head Neck Surg. 1999;125:670-675-->