Effectiveness of superselective and selective neck dissection for advanced nodal metastases after chemoradiation

Objective: To determine the efficacy of selective and superselective neck dissection for patients with bulky or residual nodal metastasis treated with concomitant intra-arterial cisplatin and radiotherapy. Design: Prospective study. Setting: University of Tennessee, Memphis. Patients: A total of 240 patients with stage III or IV head and neck squamous cell carcinoma. Interventions: Treatment with cisplatin, 150mg/m ² intra-arterially, and sodium thiosulfate, 9 g/m ² intravenously, weekly for 4 weeks; and radiotherapy, 2 Gy per fraction per day, 5 times weekly, for a total of 68 to 74 Gy over 6 to 7 weeks. Main Outcome Measures: Regional control, distant metastases, and overall survival for patients undergoing radical or modified radical neck dissection (n=12), selective neck dissection (n=65), and superselective neck dissection (levels II-III only) (n=7). Results: Among the total group of 240 patients, 106 neck dissections were performed on 84 patients who had bulky nodal disease. With a median follow-up of 58 months (range, 12-96 months), regional failure occurred in 11 (4.6%) of 240 patients: 2 (17%) of the 12 who had modified radical neck dissection, 3 (5%) of the 65 who had selective neck dissection, none of the 7 patients who had superselective neck dissection, and 6 (4%) of the 156 who had no neck dissection. The rates of overall survival and distant metastases were not significantly different among the 3 neck dissection subsets. Conclusion: Selective and superselective neck dissection, which spare function and minimize morbidity, are viable therapeutic alternatives for patients with residual disease confined to 1 level after intra-arterial chemoradiation treatment, and possibly for other chemoradiation protocols.