Superselective Neck Dissection After ChemoradiationFeasibility Based on Clinical and Pathologic Comparisons

Abstract

Chemoradiation has become an important treatment option for advanced head and neck cancer. When compared with radiation therapy alone, the results have shown significant improvement in the rates of local and regional disease control and some modest improvement in overall survival.1 Also, the combination of chemotherapy and radiation therapy administered concurrently appears to be more potent than sequential chemoradiation therapy. Despite the success of this approach, there continues to be controversy on how to manage the associated nodal disease. The common approach used by head and neck surgeons is to perform surgical salvage in the manner that has been well accepted and used based on historical experience with patients who were treated with definitive radiation therapy only. Within this framework, it is a commonly held dictum that persistent or recurrent disease should be managed with surgical procedures that are all encompassing or radical as opposed to those that specifically address the levels of the neck that are at greatest risk.