Long-term Neck Control Rates After Complete Response to Chemoradiation in Patients with Advanced Head and Neck Cancer

Reviewer: Charles Wood, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 13, 2006

Presenter: R. Rengan
Presenter's Affiliation: Memorial Sloan-Kettering Cancer Center
Type of Session: Scientific


  • The indications for planned neck dissection in patients with advanced head and neck cancer who achieve a complete response to chemoradiation are unclear
  • This study sought to evaluate outcomes in advanced head and neck cancer patients enrolled into organ-sparing protocols at Memorial-Sloan Kettering Cancer Center (MSKCC)

Materials and Methods

  • Between 1983 and 1996, 213 patients with head and neck cancer were entered into larynx/organ-sparing protocols consisting of induction cisplatin chemotherapy, followed by radiation with or without concurrent platinum chemotherapy
  • 190 patients were protocol-eligible and completed treatment at MSKCC
    • Of these patients, the following were excluded:
      • 47 patients undergoing pre-radiotherapy neck dissection
      • 1 patient who declined to further radiotherapy after 18 Gy 
  • 86 of the remaining 142 patients presented with node-positive disease and were included in this analysis
    • 29% (N=25) with N1
    • 62% (N=53) with N2
    • 9% (N=8) with N3
  • Patients received a median dose of 70 Gy (range 44-72) to the gross tumor volume, in conventional 1.8-2 Gy daily fractions, or via a concomitant boost technique delivered over the latter part of the radiotherapy course
  • Clinical response was determined via physical examination and imaging studies


  • The median follow-up duration for surviving patients was 9 years
  • 69 patients (80%) achieved a clinical complete response (CCR)
    • N1: 92% (23/25)
    • N2: 79% (42/53)
    • N3: 50% (4/8)
  • 4 patients underwent immediate neck dissection following completion of chemoradiation and were excluded from the neck failure (NF) analysis
  • Of the remaining 65 patients, the 10-year actuarial NF incidence was 14%
    • N1: 13%
    • N2: 15%
    • N3: 0%
  • The median overall of the patients within the NF analysis by nodal stage was as follows:
    • N1: 12.2 years
    • N2: 6.5 years
    • N3: 0.8 years
  • 17 patients (20%) did not achieve a CCR
    • N1: 8% (2/25)
    • N2: 21% (11/53)
    • N3: 50% (4/8)
  • 14/17 patients not achieving a CCR underwent neck dissection, with 10 (71%) having pathologically-involved nodes
  • The median survival of patients not achieving a CCR was 1.4 years

Author's Conclusions

  • The majority of patients with node-positive head and neck cancer achieving a CCR to chemoradiation demonstrate long-term disease control in the neck
  • The utility of functional imaging in this patient subset remains largely undefined, and may prove valuable in identifying the 10-15% of patients who will ultimately experience a relapse in the neck

Clinical/Scientific Implications

The question of when to proceed with a post-chemoradiation neck dissection in patients with an excellent response to treatment remains largely unanswered. This study, though somewhat limited in size and retrospective, suggests that the majority of patients demonstrating a CCR to chemoradiation may be adequately managed without a neck dissection. Predicting those that will ultimately experience neck relapse, however, is a more difficult task, and, as suggested by the authors, an area in which functional imaging might prove valuable.


Eight Tips for Addressing Medical Billing Issues
by Christina Bach, MSW, LCSW, OSW-C
May 25, 2016