Management of the neck following definitive radiotherapy with or without chemoradiotherapy in head and neck squamous cell carcinoma
- Sandro V Porceddu, MD
Sandro V Porceddu, MD
- Radiation Oncologist, Princess Alexandra Hospital
- Associate Professor, University of Queensland
- Randal S Weber, MD
Randal S Weber, MD
- Professor and Chairman
- Department of Head and Neck Surgery
- The University of Texas MD Anderson Cancer Center
- Section Editors
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marshall R Posner, MD
Marshall R Posner, MD
- Section Editor — Cancer of the Head and Neck
- Professor of Gene and Cell Medicine
- The Tisch Cancer Institute
- Icahn School of Medicine at Mount Sinai
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
Management of the neck in patients with metastatic involvement of cervical lymph nodes from a mucosal primary head and neck squamous cell carcinoma (HNSCC) has evolved with the increasing use of definitive radiotherapy (RT), either alone or in combination with chemotherapy. The neck is typically irradiated in continuity with the primary site if there is clinical/radiologic evidence of nodal disease or if the perceived risk of subclinical disease (N0) in the neck exceeds 15 to 20 percent. (See "Locally advanced squamous cell carcinoma of the head and neck: Approaches combining chemotherapy and radiation therapy".)
Traditionally, up to 40 to 50 percent of node positive patients with HNSCC managed with RT alone had persistent nodal disease on pathology, which provided the rationale for a planned neck dissection following definitive RT [1,2]. However, this approach meant that a substantial number of patients would undergo unnecessary surgery, with its associated morbidity.
The management of node positive HNSCC in patients who achieve a complete response at the primary site following RT is discussed here. Recommendations for treatment according to the primary site of disease are presented separately:
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- GENERAL APPROACH
- Neck dissection
- - Extent of neck dissection
- Planned surgery versus PET/CT surveillance
- RESTAGING INVESTIGATIONS
- Structural imaging
- Functional imaging
- Impact of changing biology of HNSCC
- Emerging imaging techniques
- Fine needle aspiration and cytology
- MANAGEMENT OF A RESIDUAL NODE
- LONG-TERM SURVEILLANCE