Planned early neck dissection before radiation for persistent neck nodes after induction chemotherapy

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Cancer Research

Background:

• Optimal management of advanced neck metastases in head and neck squamous carcinoma (HNSC) within organ preservation strategies remains unclear.
• A modified management paradigm incorporates planned early neck dissection for patients with incomplete nodal response after induction chemotherapy (IC).

Purpose of the Study:

• To evaluate the safety and efficacy of planned early neck dissection for advanced nodal disease in HNSC organ preservation.
• To determine if planned early neck dissection impacts recurrence, complications, or survival rates.

Main Methods:

• Retrospective analysis of 58 consecutive advanced HNSC patients in organ preservation trials.
• Patients received induction chemotherapy (IC) followed by radiation therapy with surgical salvage.
• Group analysis based on nodal response (complete response [CR] vs. less than CR) to IC.

Main Results:

• 49% of patients achieved CR of neck nodes after IC; 51% required planned early neck dissection.
• No significant differences observed in recurrence patterns, complications, or survival rates between CR and less than CR groups.
• Median follow-up was 26 months, with 71% of patients presenting at Stage IV.

Conclusions:

• Planned early neck dissection for HNSC patients with less than CR after IC is not detrimental to neck relapse or overall survival.
• This approach can be safely integrated into future organ preservation treatment protocols for advanced HNSC.
• Early neck dissection offers a viable option for managing advanced nodal disease in organ preservation settings.