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Postradiotherapy Neck Dissection for Lymph Node–Positive Head and Neck Cancer: The Use of Computed Tomography to Manage the Neck

Stanley L. Liauw, Anthony A. Mancuso, Robert J. Amdur, Christopher G. Morris, Douglas B. Villaret, John W. Werning, William M. Mendenhall

From the Departments of Radiation Oncology, Radiology, and Otolaryngology, University of Florida College of Medicine, Gainesville, FL

Address reprint requests to William M. Mendenhall, MD, Department of Radiation Oncology, University of Florida Health Science Center, P.O. Box 100385, Gainesville, FL 32610-0385; e-mail: mendewil{at}shands.ufl.edu

PURPOSE: To determine how to use node response on computed tomography (CT) to indicate the need for neck dissection.

PATIENTS AND METHODS: Five hundred fifty patients with lymph node–positive head and neck cancer were treated between 1990 and 2002 with radiotherapy (RT) at a median dose of 74.4 Gy; 24% of these patients (n = 133) were treated with chemotherapy. Three hundred forty-one patients (62%) underwent planned post-RT neck dissection. Physical examination and contrast-enhanced CT were performed 30 days after completion of RT. CT images were reviewed in 211 patients for lymph node size (largest axial dimension) and presence of a focal abnormality (lucency, enhancement, or calcification). By correlating post-RT CT to neck dissection pathology, criteria associated with a low likelihood of residual disease were identified. A subset of patients who fit these criteria of radiographic response who did not undergo post-RT neck dissection was observed for recurrence.

RESULTS: Radiographic complete response (rCR) was defined as the absence of any large (> 1.5 cm) or focally abnormal lymph node. Correlation of response with neck dissection pathology indicated a negative predictive value of 77% for complete clinical response and 94% for rCR. In 32 patients (median follow-up time, 3.2 years) with rCR who did not undergo post-RT neck dissection, the 5-year ultimate neck control rate (100%) and cause-specific survival rate (72%) were not significantly different from the rates of patients with a negative post-RT neck dissection.

CONCLUSION: Patients with rCR 4 weeks after RT can be spared from a post-RT neck dissection regardless of initial node stage.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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