Observation versus neck dissection for positron-emission tomography-negative lymphadenopathy after chemoradiotherapy

• Published in: The Laryngoscope Vol. 124; no. 4; pp. 902 - 906
• Main Authors: Khodayari, Behnood, Daly, Megan E., Bobinski, Matthew, Farwell, D. Gregory, Shelton, David K., Chen, Allen M.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-04-2014; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; cancer; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy; Chemotherapy; Diagnosis, Differential; Disease-Free Survival; Dissection; Female; Follow-Up Studies; Head & neck cancer; Head and Neck Neoplasms - epidemiology; Head and Neck Neoplasms - secondary; Head and Neck Neoplasms - therapy; Humans; Immunoblastic Lymphadenopathy - diagnostic imaging; Immunoblastic Lymphadenopathy - etiology; Incidence; lymphadenopathy; Lymphatic Metastasis; Male; Middle Aged; Neck; Neck Dissection - methods; Neoplasm Recurrence, Local; Neoplasm Staging; observation; positron-emission tomography; Positron-Emission Tomography - methods; Prognosis; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck; Survival Rate - trends; United States - epidemiology; United States; positron-emission tomography; cancer; lymphadenopathy; Chemoradiotherapy; observation
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.24411

Objectives/Hypothesis
To analyze outcomes among patients with residual positron‐emission tomography (PET)‐negative lymphadenopathy after chemoradiotherapy for head and neck cancer based on whether or not they underwent neck dissection.
Study Design
Retrospective review.
Methods
Fifty‐five patients with stage III/IV squamous cell carcinoma of the head and neck were identified with residual PET‐negative lymphadenopathy based on standardized uptake value of <3. All patients had been treated with chemoradiotherapy to a median dose of 70 Gy (range, 60–4 Gy).
Results
With a median follow‐up of 30 months (range, 6–67 months), the 3‐year overall survival (85% vs. 81%, P = .57), progression‐free survival (88% vs. 88%, P = .42), and local‐regional control (96% vs. 100%, P = .68), did not differ between patients treated by neck dissection or observation.
Conclusions
Omission of neck dissection appears to be reasonable for patients with residual lymphadenopathy but negative PET after chemoradiotherapy for head and neck cancer.
Level of Evidence
4. Laryngoscope, 124:902–906, 2014