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Updated: Jun 21, 2026
Modified Radical Neck Dissection for Cervical Metastasis
Published on: February 20, 2026
Extent of neck dissection required after concurrent chemoradiation for stage IV head and neck squamous cell carcinoma
Steven B Cannady1, Walter T Lee, Joseph Scharpf
1Department of Otolaryngology, Oregon Health Sciences University, Portland, Oregon, USA. stevencannady@hotmail.com
Background:
The management of initially bulky nodal disease after primary nonsurgical treatment for stage IV head and neck squamous cell carcinoma (HNSCC) continues to be a subject of debate.
Methods:
A retrospective chart review of neck management in patients after chemoradiation was performed.
Results:
Of the initially positive necks analyzed, 210/329 (65%) had a complete clinical response to treatment and 161 necks underwent neck surgery. Patients were pathologically positive 13.8% and 39.6% of the time after clinical complete or partial response, respectively. Regional recurrence was more frequent in necks with partial clinical (p = .04) or pathologic responses (p < .01) and with primary site recurrences (p < .01).
Conclusions:
It is still safest at our institution to perform selective neck dissection on patients with > or = N2 neck disease when initially observed to prevent unsalvageable regional recurrence until more accurate interval assessment tools are confirmed.
