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Recurrence Rates After Selective Neck Dissection in the N0 Irradiated Neck
Michael A. Fritz, MD;
Ramon M. Esclamado, MD;
Robert R. Lorenz, MD;
Benjamin G. Wood, MD;
Pierre Lavertu, MD;
Marshall Strome, MD
Arch Otolaryngol Head Neck Surg. 2002;128:292-295.
Objectives To define patterns of subclinical metastases in irradiated N0 necks
with recurrent or persistent primary site disease and to determine the regional
control rate when selective neck dissection (SND) is used in this setting.
Patients and Intervention Individuals included were previously treated for head and neck squamous
cell carcinoma with primary radiation therapy or chemoradiotherapy. All had
recurrent or persistent disease at the primary site, with no clinical or radiographic
evidence of nodal disease. The patients underwent surgical treatment of the
primary site along with site-specific SND and were required to undergo at
least 1 year of follow-up. Subsequent recurrence at the primary site disqualified
the patient from further evaluation.
Main Outcome Measure Regional tumor control.
Results Forty-three patients meeting the inclusion criteria underwent 59 SNDs
(levels dissected: I-IV [n = 22], II-IV [n = 34], and I-III [n = 3]). Sixteen
specimens were positive for nodal disease. The charts of 26 patients, who
underwent a total of 35 SNDs, were available for review after 1 year (none
of the patients involved died of disease in the neck). There were no neck
recurrences (mean follow-up, 25 months; median, 21 months). All patients with
more than 2 occult nodal metastases experienced primary site recurrence or
distant metastases.
Conclusions In this small cohort, SND in previously irradiated patients with recurrent
primary disease but clinically negative necks has resulted in excellent tumor
control in the neck. The usual patterns of nodal spread do not appear to be
significantly altered with primary site recurrence after radiation therapy.
The presence of more than 2 positive nodes in the neck specimen correlates
with poor prognosis.
From the Department of Otolaryngology and Communicative Disorders,
Cleveland Clinic Foundation(Drs Fritz, Esclamado, Lorenz, Wood and Strome),
and the Department of Otolaryngology, University Hospitals of Cleveland (Dr
Lavertu), Cleveland, Ohio.
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