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Management of the "violated neck" in the era of chemoradiation.
Laryngoscope 2011; 121(11):2349-58L

Abstract

OBJECTIVES

To determine if patients who have undergone an open neck biopsy (a "violated" neck) have improved disease control and survival with completion neck dissection.

MATERIALS AND METHODS

Retrospective review of patients who underwent open cervical biopsy for diagnosis prior to definitive treatment between February 1997 and February 2010 at two academic tertiary referral centers.

RESULTS

Ninety-four patients met study criteria, with completion neck dissection performed in 53 patients (56%). The majority of patients (84%) had oropharyngeal tumors. Human papilloma virus (HPV) status was positive in 55 of 63 patients (87%). Chemotherapy was used more often in patients treated nonoperatively (88%) compared to patients who underwent neck dissection (49%; P < .001). Five-year disease-specific survival (DSS) was 84% for patients treated with neck dissection and 82% for nonoperative treatment (P = .5806), and disease-free survival (DFS) was 82% for patients treated with neck dissection and 70% for nonoperative treatment (P = .6047). Five-year DSS was 84% for patients with HPV-positive disease and 63% for HPV-negative disease (P = .0086), and DFS was 79% for HPV-positive disease and 50% for HPV-negative disease (P = .0004). Only advanced primary tumor (T3/T4) stage (hazard ratio [HR] = 8.8, P = .004) was associated with DSS, whereas advanced primary tumor stage (HR = 5.3, P = .008), N3 disease (HR = 5.6, P = .036), and HPV-positive disease (HR = 0.2, P = .032) were significant predictors of DFS, after controlling for all other variables.

CONCLUSIONS

In the era of chemoradiation, completion neck dissection following an open cervical biopsy does not appear to provide a survival advantage. A high proportion of HPV-positive oropharyngeal tumors may explain the favorable outcomes observed.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21993776

Citation

Loyo, Myriam, et al. "Management of the "violated Neck" in the Era of Chemoradiation." The Laryngoscope, vol. 121, no. 11, 2011, pp. 2349-58.
Loyo M, Johnson JT, Westra WH, et al. Management of the "violated neck" in the era of chemoradiation. Laryngoscope. 2011;121(11):2349-58.
Loyo, M., Johnson, J. T., Westra, W. H., Chiosea, S. I., & Gourin, C. G. (2011). Management of the "violated neck" in the era of chemoradiation. The Laryngoscope, 121(11), pp. 2349-58. doi:10.1002/lary.22186.
Loyo M, et al. Management of the "violated Neck" in the Era of Chemoradiation. Laryngoscope. 2011;121(11):2349-58. PubMed PMID: 21993776.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of the "violated neck" in the era of chemoradiation. AU - Loyo,Myriam, AU - Johnson,Jonas T, AU - Westra,William H, AU - Chiosea,Simion I, AU - Gourin,Christine G, Y1 - 2011/10/12/ PY - 2011/05/20/received PY - 2011/06/17/accepted PY - 2011/10/14/entrez PY - 2011/10/14/pubmed PY - 2011/12/14/medline SP - 2349 EP - 58 JF - The Laryngoscope JO - Laryngoscope VL - 121 IS - 11 N2 - OBJECTIVES: To determine if patients who have undergone an open neck biopsy (a "violated" neck) have improved disease control and survival with completion neck dissection. MATERIALS AND METHODS: Retrospective review of patients who underwent open cervical biopsy for diagnosis prior to definitive treatment between February 1997 and February 2010 at two academic tertiary referral centers. RESULTS: Ninety-four patients met study criteria, with completion neck dissection performed in 53 patients (56%). The majority of patients (84%) had oropharyngeal tumors. Human papilloma virus (HPV) status was positive in 55 of 63 patients (87%). Chemotherapy was used more often in patients treated nonoperatively (88%) compared to patients who underwent neck dissection (49%; P < .001). Five-year disease-specific survival (DSS) was 84% for patients treated with neck dissection and 82% for nonoperative treatment (P = .5806), and disease-free survival (DFS) was 82% for patients treated with neck dissection and 70% for nonoperative treatment (P = .6047). Five-year DSS was 84% for patients with HPV-positive disease and 63% for HPV-negative disease (P = .0086), and DFS was 79% for HPV-positive disease and 50% for HPV-negative disease (P = .0004). Only advanced primary tumor (T3/T4) stage (hazard ratio [HR] = 8.8, P = .004) was associated with DSS, whereas advanced primary tumor stage (HR = 5.3, P = .008), N3 disease (HR = 5.6, P = .036), and HPV-positive disease (HR = 0.2, P = .032) were significant predictors of DFS, after controlling for all other variables. CONCLUSIONS: In the era of chemoradiation, completion neck dissection following an open cervical biopsy does not appear to provide a survival advantage. A high proportion of HPV-positive oropharyngeal tumors may explain the favorable outcomes observed. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/21993776/Management_of_the_"violated_neck"_in_the_era_of_chemoradiation_ L2 - https://doi.org/10.1002/lary.22186 DB - PRIME DP - Unbound Medicine ER -