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Is planned neck dissection necessary for head and neck cancer after intensity-modulated radiotherapy?
Int J Radiat Oncol Biol Phys. 2007 Jul 01; 68(3):707-13.IJ

Abstract

PURPOSE

The objective of this study was to determine regional control of local regional advanced head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiotherapy (IMRT), along with the role and selection criteria for neck dissection after IMRT.

METHODS AND MATERIALS

A total of 90 patients with stage N2A or greater HNSCC were treated with definitive IMRT from December 1999 to July 2005. Three clinical target volumes were defined and were treated to 70 to 74 Gy, 60 Gy, and 54 Gy, respectively. Neck dissection was performed for selected patients after IMRT. Selection criteria evolved during this period with emphasis on post-IMRT [(18)F] fluorodeoxyglucose positron emission tomography in recent years.

RESULTS

Median follow-up for all patients was 29 months (range, 0.2-74 months). All living patients were followed at least 9 months after completing treatment. Thirteen patients underwent neck dissection after IMRT because of residual lymphadenopathy. Of these, 6 contained residual viable tumor. Three patients with persistent adenopathy did not undergo neck dissection: 2 refused and 1 had lung metastasis. Among the remaining 74 patients who were observed without neck dissection, there was only 1 case of regional failure. Among all 90 patients in this study, the 3-year local and regional control was 96.3% and 95.4%, respectively.

CONCLUSIONS

Appropriately delivered IMRT has excellent dose coverage for cervical lymph nodes. A high radiation dose can be safely delivered to the abnormal lymph nodes. There is a high complete response rate. Routine planned neck dissection for patients with N2A and higher stage after IMRT is not necessary. Post-IMRT [(18)F] fluorodeoxyglucose positron emission tomography is a useful tool in selecting patients appropriate for neck dissection.

Authors+Show Affiliations

Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa Health Care, Iowa City, IA 52242, USA. min-yao@uiowa.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17379453

Citation

Yao, Min, et al. "Is Planned Neck Dissection Necessary for Head and Neck Cancer After Intensity-modulated Radiotherapy?" International Journal of Radiation Oncology, Biology, Physics, vol. 68, no. 3, 2007, pp. 707-13.
Yao M, Hoffman HT, Chang K, et al. Is planned neck dissection necessary for head and neck cancer after intensity-modulated radiotherapy? Int J Radiat Oncol Biol Phys. 2007;68(3):707-13.
Yao, M., Hoffman, H. T., Chang, K., Funk, G. F., Smith, R. B., Tan, H., Clamon, G. H., Dornfeld, K., & Buatti, J. M. (2007). Is planned neck dissection necessary for head and neck cancer after intensity-modulated radiotherapy? International Journal of Radiation Oncology, Biology, Physics, 68(3), 707-13.
Yao M, et al. Is Planned Neck Dissection Necessary for Head and Neck Cancer After Intensity-modulated Radiotherapy. Int J Radiat Oncol Biol Phys. 2007 Jul 1;68(3):707-13. PubMed PMID: 17379453.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is planned neck dissection necessary for head and neck cancer after intensity-modulated radiotherapy? AU - Yao,Min, AU - Hoffman,Henry T, AU - Chang,Kristi, AU - Funk,Gerry F, AU - Smith,Russell B, AU - Tan,Huaming, AU - Clamon,Gerald H, AU - Dornfeld,Ken, AU - Buatti,John M, Y1 - 2007/03/26/ PY - 2006/11/28/received PY - 2006/12/28/revised PY - 2006/12/28/accepted PY - 2007/3/24/pubmed PY - 2007/8/2/medline PY - 2007/3/24/entrez SP - 707 EP - 13 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 68 IS - 3 N2 - PURPOSE: The objective of this study was to determine regional control of local regional advanced head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiotherapy (IMRT), along with the role and selection criteria for neck dissection after IMRT. METHODS AND MATERIALS: A total of 90 patients with stage N2A or greater HNSCC were treated with definitive IMRT from December 1999 to July 2005. Three clinical target volumes were defined and were treated to 70 to 74 Gy, 60 Gy, and 54 Gy, respectively. Neck dissection was performed for selected patients after IMRT. Selection criteria evolved during this period with emphasis on post-IMRT [(18)F] fluorodeoxyglucose positron emission tomography in recent years. RESULTS: Median follow-up for all patients was 29 months (range, 0.2-74 months). All living patients were followed at least 9 months after completing treatment. Thirteen patients underwent neck dissection after IMRT because of residual lymphadenopathy. Of these, 6 contained residual viable tumor. Three patients with persistent adenopathy did not undergo neck dissection: 2 refused and 1 had lung metastasis. Among the remaining 74 patients who were observed without neck dissection, there was only 1 case of regional failure. Among all 90 patients in this study, the 3-year local and regional control was 96.3% and 95.4%, respectively. CONCLUSIONS: Appropriately delivered IMRT has excellent dose coverage for cervical lymph nodes. A high radiation dose can be safely delivered to the abnormal lymph nodes. There is a high complete response rate. Routine planned neck dissection for patients with N2A and higher stage after IMRT is not necessary. Post-IMRT [(18)F] fluorodeoxyglucose positron emission tomography is a useful tool in selecting patients appropriate for neck dissection. SN - 0360-3016 UR - https://www.unboundmedicine.com/medline/citation/17379453/Is_planned_neck_dissection_necessary_for_head_and_neck_cancer_after_intensity_modulated_radiotherapy L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(07)00119-8 DB - PRIME DP - Unbound Medicine ER -