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Management of the neck following definitive radiotherapy with or without chemoradiotherapy in head and neck squamous cell carcinoma

Sandro V Porceddu, MD
Randal S Weber, MD
Section Editors
Marvin P Fried, MD, FACS
David M Brizel, MD
Marshall R Posner, MD
Bruce E Brockstein, MD
Deputy Editor
Michael E Ross, MD


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:

(See "Treatment of locoregionally advanced (stage III and IV) head and neck cancer: The larynx and hypopharynx".)

(See "Treatment of locoregionally advanced (stage III and IV) head and neck cancer: The oral cavity".)

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Literature review current through: Nov 2017. | This topic last updated: Oct 10, 2016.
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