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The N3 neck: outcomes following primary chemoradiotherapy
Roger V Moukarbel1, Kevin Fung, Varagur Venkatesan
1Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON.
Objective:
To study the treatment outcomes of N3 neck disease following primary chemoradiotherapy.
Design:
Retrospective cohort.
Setting:
Tertiary care centre.
Methods:
A review was conducted of 25 consecutive patients with N3 neck disease treated with primary platinum-based chemoradiotherapy. A neck dissection (ND) was offered in the event of clinical and/or radiologic evidence of residual disease on follow-up.
Main Outcome Measures:
Recurrence-free, disease-specific, and overall survival and patterns of failure.
Results:
A regional complete response (CR) was noted in 48% of the patients. ND was performed in 36% of the cases. The median duration between the end of radiation and ND was 71 days. The recurrence-free survival rates at 1 and 2 years were 73% and 64%, respectively. The 2-, 3-, and 5-year overall survival rates were 66.7%, 52%, and 31.2%, respectively. Disease-specific survival rates were 69.6%, 63.3%, and 50.6%, respectively. Nine patients developed distant recurrence, with one having concurrent local and regional recurrence as well. Patients in the CR group remained free of regional recurrence. Among the initial partial responders, 54% eventually developed distant metastasis compared to 17% in the CR group.
Conclusion:
Patients with N3 disease may be managed with chemoradiotherapy, with ND reserved for salvage. Distant metastasis accounts for most recurrences and for the reduction in survival.
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