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Complete Radiographic Response Correlates With Pathologic Complete Response in Locoregionally Advanced Head and Neck Cancer

Alexander Langerman, MD; Colleen Plein, BA; Everett E. Vokes, MD; Joseph K. Salama, MD; Daniel J. Haraf, MD; Elizabeth A. Blair, MD; Kerstin M. Stenson, MD

Arch Otolaryngol Head Neck Surg. 2009;135(11):1133-1136.

Objective  The role of neck dissection following chemoradiotherapy (CRT) for locoregionally advanced head and neck cancer is an area of active debate. Patients who have a complete radiographic response may not need dissection, and the extent of neck dissection necessary for those patients with residual disease is unclear.

Design  Retrospective review of data from a prospectively collected database of patients with locoregionally advanced head and neck cancer treated as part of a phase 2 study of induction chemotherapy followed by concurrent CRT. The results of post-CRT neck computed tomography (CT) imaging and pathologic analysis of the neck dissection specimens were compared to evaluate correlation between radiographic and pathologic response.

Results  Forty-nine patients underwent 61 hemineck dissections. Overall, 209 neck levels were dissected. Radiologic complete response in the neck was achieved in 39 patients, all of whom had pathologic specimens negative for tumor cells. Ten patients (20%) had a total of 14 neck levels with residual disease on CT imaging. Five (50%) of these 10 patients were found to have residual tumor cells on pathologic analysis. Tumor cells were contained only to those levels found positive on CT imaging; they were present in 7 (50%) of the 14 positive levels.

Conclusions  Neck levels with residual disease on post-CRT CT imaging warrant removal. However, neck levels without evidence of disease on post-CRT CT imaging are unlikely to harbor cancer, which lends further support to the concept of basing neck dissection on post-CRT staging and performance of limited neck dissections for patients with limited residual disease.

Author Affiliations: Sections of Otolaryngology–Head and Neck Surgery (Drs Langerman, Blair, and Stenson and Ms Plein) and Hematology–Oncology (Dr Vokes), Department of Radiation and Cellular Oncology (Drs Vokes, Salama, and Haraf), and Department of Surgery, Cancer Research Center (Drs Vokes, Salama, and Haraf), University of Chicago, Chicago, Illinois.

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