Effectiveness of Salvage Selective and Modified Radical Neck Dissection for Regional Pathologic Lymphadenopathy After Chemoradiation

L. van der Putten; G.B. van den Broek; R. de Bree; M.W.M. van den Brekel; A.J. Balm; F.J.P. Hoebers; P.A.H. Doornaert; C.R. Leemans; C. Rasch

doi:https://doi.org/10.1002/hed.20987

Effectiveness of Salvage Selective and Modified Radical Neck Dissection for Regional Pathologic Lymphadenopathy After Chemoradiation

L. van der Putten, G.B. van den Broek, R. de Bree, M.W.M. van den Brekel, A.J. Balm, F.J.P. Hoebers, P.A.H. Doornaert, C.R. Leemans, C. Rasch

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background. The objective of this study was to evaluate the effectiveness and safety of our careful observational strategy and neck dissections and the accuracy of ultrasound-guided fine-needle aspiration cytology, and to determine the prognostic factors for outcome and regional control after primary chemoradiation. Diagnostic evaluation of the regional status after concurrent chemoradiation for advanced head and neck cancer remains difficult, and the indications for a salvage neck dissection and its extent are not clearly defined. Methods. In a series of 540 patients, there was suspicion of regional residual or recurrent disease after chemoradiation in 61 patients who underwent 68 salvage neck dissections and 68 patients who were considered unresectable. For the patients with salvage neck dissection, the accuracy of ultrasound-guided fine-needle aspiration cytology was determined. Disease control in the neck, disease-specific and overall survival, and parameters that may have prognostic value for the outcome were evaluated. Results. Neck dissection specimens contained viable tumor in 26 (43%) patients. Of these, 13 had selective neck dissections and 13 modified radical neck dissections. Ultrasound-guided fine-needle aspiration cytology had a sensitivity of 80% and specificity of 42%. Nine patients developed a regional recurrence after salvage neck dissection (5 located in contralateral neck). Five-year regional control and overall survival rates were 79% and 36%, respectively. Significant prognostic factors for overall survival were surgical margins and "residual versus recurrent disease" in multivariate analysis. Conclusion. Considering the good regional control rate and the high rate of unnecessary neck dissections with a theoretical planned neck dissection strategy, we conclude that a careful observational strategy is worthwhile and safe. For the evaluation of radiation treatment response, ultrasound-guided fine-needle aspiration cytology has a low specificity. (C) 2009 Wiley Periodicals, Inc. Head Neck 31: 593-603, 2009

Original language	Undefined/Unknown
Pages (from-to)	593-603
Journal	Head and Neck
Volume	31
Issue number	5
DOIs	https://doi.org/10.1002/hed.20987
Publication status	Published - 2009

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https://doi.org/10.1002/hed.20987

Cite this

@article{28ae034ee4ed4422a52b19066c8fbb23,

title = "Effectiveness of Salvage Selective and Modified Radical Neck Dissection for Regional Pathologic Lymphadenopathy After Chemoradiation",

abstract = "Background. The objective of this study was to evaluate the effectiveness and safety of our careful observational strategy and neck dissections and the accuracy of ultrasound-guided fine-needle aspiration cytology, and to determine the prognostic factors for outcome and regional control after primary chemoradiation. Diagnostic evaluation of the regional status after concurrent chemoradiation for advanced head and neck cancer remains difficult, and the indications for a salvage neck dissection and its extent are not clearly defined. Methods. In a series of 540 patients, there was suspicion of regional residual or recurrent disease after chemoradiation in 61 patients who underwent 68 salvage neck dissections and 68 patients who were considered unresectable. For the patients with salvage neck dissection, the accuracy of ultrasound-guided fine-needle aspiration cytology was determined. Disease control in the neck, disease-specific and overall survival, and parameters that may have prognostic value for the outcome were evaluated. Results. Neck dissection specimens contained viable tumor in 26 (43%) patients. Of these, 13 had selective neck dissections and 13 modified radical neck dissections. Ultrasound-guided fine-needle aspiration cytology had a sensitivity of 80% and specificity of 42%. Nine patients developed a regional recurrence after salvage neck dissection (5 located in contralateral neck). Five-year regional control and overall survival rates were 79% and 36%, respectively. Significant prognostic factors for overall survival were surgical margins and {"}residual versus recurrent disease{"} in multivariate analysis. Conclusion. Considering the good regional control rate and the high rate of unnecessary neck dissections with a theoretical planned neck dissection strategy, we conclude that a careful observational strategy is worthwhile and safe. For the evaluation of radiation treatment response, ultrasound-guided fine-needle aspiration cytology has a low specificity. (C) 2009 Wiley Periodicals, Inc. Head Neck 31: 593-603, 2009",

author = "{van der Putten}, L. and {van den Broek}, G.B. and {de Bree}, R. and {van den Brekel}, M.W.M. and A.J. Balm and F.J.P. Hoebers and P.A.H. Doornaert and C.R. Leemans and C. Rasch",

year = "2009",

doi = "https://doi.org/10.1002/hed.20987",

language = "Undefined/Unknown",

volume = "31",

pages = "593--603",

journal = "Head and Neck",

issn = "1043-3074",

publisher = "John Wiley and Sons Inc.",

number = "5",

}

TY - JOUR

T1 - Effectiveness of Salvage Selective and Modified Radical Neck Dissection for Regional Pathologic Lymphadenopathy After Chemoradiation

AU - van der Putten, L.

AU - van den Broek, G.B.

AU - de Bree, R.

AU - van den Brekel, M.W.M.

AU - Balm, A.J.

AU - Hoebers, F.J.P.

AU - Doornaert, P.A.H.

AU - Leemans, C.R.

AU - Rasch, C.

PY - 2009

Y1 - 2009

N2 - Background. The objective of this study was to evaluate the effectiveness and safety of our careful observational strategy and neck dissections and the accuracy of ultrasound-guided fine-needle aspiration cytology, and to determine the prognostic factors for outcome and regional control after primary chemoradiation. Diagnostic evaluation of the regional status after concurrent chemoradiation for advanced head and neck cancer remains difficult, and the indications for a salvage neck dissection and its extent are not clearly defined. Methods. In a series of 540 patients, there was suspicion of regional residual or recurrent disease after chemoradiation in 61 patients who underwent 68 salvage neck dissections and 68 patients who were considered unresectable. For the patients with salvage neck dissection, the accuracy of ultrasound-guided fine-needle aspiration cytology was determined. Disease control in the neck, disease-specific and overall survival, and parameters that may have prognostic value for the outcome were evaluated. Results. Neck dissection specimens contained viable tumor in 26 (43%) patients. Of these, 13 had selective neck dissections and 13 modified radical neck dissections. Ultrasound-guided fine-needle aspiration cytology had a sensitivity of 80% and specificity of 42%. Nine patients developed a regional recurrence after salvage neck dissection (5 located in contralateral neck). Five-year regional control and overall survival rates were 79% and 36%, respectively. Significant prognostic factors for overall survival were surgical margins and "residual versus recurrent disease" in multivariate analysis. Conclusion. Considering the good regional control rate and the high rate of unnecessary neck dissections with a theoretical planned neck dissection strategy, we conclude that a careful observational strategy is worthwhile and safe. For the evaluation of radiation treatment response, ultrasound-guided fine-needle aspiration cytology has a low specificity. (C) 2009 Wiley Periodicals, Inc. Head Neck 31: 593-603, 2009

AB - Background. The objective of this study was to evaluate the effectiveness and safety of our careful observational strategy and neck dissections and the accuracy of ultrasound-guided fine-needle aspiration cytology, and to determine the prognostic factors for outcome and regional control after primary chemoradiation. Diagnostic evaluation of the regional status after concurrent chemoradiation for advanced head and neck cancer remains difficult, and the indications for a salvage neck dissection and its extent are not clearly defined. Methods. In a series of 540 patients, there was suspicion of regional residual or recurrent disease after chemoradiation in 61 patients who underwent 68 salvage neck dissections and 68 patients who were considered unresectable. For the patients with salvage neck dissection, the accuracy of ultrasound-guided fine-needle aspiration cytology was determined. Disease control in the neck, disease-specific and overall survival, and parameters that may have prognostic value for the outcome were evaluated. Results. Neck dissection specimens contained viable tumor in 26 (43%) patients. Of these, 13 had selective neck dissections and 13 modified radical neck dissections. Ultrasound-guided fine-needle aspiration cytology had a sensitivity of 80% and specificity of 42%. Nine patients developed a regional recurrence after salvage neck dissection (5 located in contralateral neck). Five-year regional control and overall survival rates were 79% and 36%, respectively. Significant prognostic factors for overall survival were surgical margins and "residual versus recurrent disease" in multivariate analysis. Conclusion. Considering the good regional control rate and the high rate of unnecessary neck dissections with a theoretical planned neck dissection strategy, we conclude that a careful observational strategy is worthwhile and safe. For the evaluation of radiation treatment response, ultrasound-guided fine-needle aspiration cytology has a low specificity. (C) 2009 Wiley Periodicals, Inc. Head Neck 31: 593-603, 2009

U2 - https://doi.org/10.1002/hed.20987

DO - https://doi.org/10.1002/hed.20987

M3 - Article

C2 - 19132716

SN - 1043-3074

VL - 31

SP - 593

EP - 603

JO - Head and Neck

JF - Head and Neck

IS - 5

ER -