Objectives: To assess if the extent of neck dissection among patients who receive adjuvant radiotherapy affects regional recurrence and survival.
Methods: This is a retrospective study of patients who had clinical metastatic mucosal Squamous Cell Carcinoma (SCC) to cervical lymph nodes done at Roswell Park Cancer Institute, Buffalo, NY from 2004 to 2015. Patients with previous radiotherapy and/or chemotherapy were excluded. All patients had surgery to the primary tumor and the neck followed by adjuvant (chemo) radiation. Patients have been divided into 2 groups according to type of neck dissection with either Selective Neck dissection (SND) vs Comprehensive Neck Dissection (CND). The extent of neck dissection was determined by surgeon preference. All patients received post-operative radiotherapy to the primary tumor bed and to the neck with or without chemotherapy. Main outcomes were measured in regional recurrence and overall survival.
Results: 98 patients were included in the study. Median follow-up was 21.0 months for SNDs group and 22.5 months for CNDs group. Among the two groups of patients, the regional recurrence was 6 of 74 patients (8.1 %) in the group who underwent SNDs vs 3 of 24 patients (12.5%) in the group who underwent CNDs. Post-operative chemotherapy was received in 49 of 74 patients (66.2%) who underwent SNDs and in 15 of 24 patients (62.5 %) who underwent CNDs. The overall survival was 46 of 74 patients (62.2%) in the group who underwent SNDs and 13 of 24 patients (54.2%) in the group who underwent CNDs (P=0.49). Disease-specific death was 23 of 74 patients (82.1%) in the group who underwent SNDs and 8 of 24 patients (72.7%) in the group who underwent CNDs (P= 0.66), the difference was not statistically Significant.
Conclusions: SND, combined with proper adjuvant (chemo) radiotherapy, achieved regional control and survival rates comparable to CND. Patients with significant nodal disease may not benefit from more aggressive surgical treatment of the neck if adjuvant radiotherapy is to be followed.