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Post-Chemoradiation of Head and Neck Cancer: SND and Aspiration

by Jennifer Decker Arevalo, MA •

The National Cancer Institute states that cancers of the head and neck account for 3% to 5% of all malignancies in the United States. Although this percentage may seem small, it still means that more than 55,000 Americans will develop cancer of the head and neck this year and nearly 13,000 of them will die from it, according to the American Academy of Otolaryngology-Head and Neck Surgery.

Two scientific sessions at the April 2007 Combined Otolaryngology Spring Meeting focused on post-chemoradiation issues related to head and neck cancer. Adam S. Jacobson, MD, from the Department of Otolaryngology-Head and Neck Surgery at the Mount Sinai School of Medicine in New York and Alexander Langerman, MD, of the University of Chicago’s Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, presented results from their studies titled, Efficacy of Selective Neck Dissection Following Adjuvant Radiation or Chemoradiation for Advanced Head and Neck Cancer and Aspiration in Chemoradiated Head and Neck Cancer Patients, respectively. Dr. Langerman’s paper has been accepted by the Archives of Otolaryngology-Head and Neck Surgery.

Selective Neck Dissection

Recent advances in medical therapy for cancers of the head and neck include combined chemoradiation and induction chemotherapy plus concomitant chemoradiation.1 Regional recurrence is common in patients with advanced nodal disease, and radical and modified radical neck dissections have long been the standard of care following primary chemoradiation.

However, there has been a gradual shift in the surgical management of advanced head and neck cancer toward selective neck dissection (SND)2,3,4 in patients with locoregionally advanced disease following definitive adjuvant therapy.5,6,7

There is an improved quality of life for patients who had SND following chemoradiation when compared to those patients who had a radical or modified radical neck dissection, said Dr. Jacobson.

Dr. Jacobson and his colleagues conducted a retrospective chart review of 58 patients with either stage III or IV squamous cell carcinoma of the upper aerodigestive tract with bulky nodal disease (N2, N3) to determine the efficacy of SND after primary radiation therapy or chemoradiation. The primary tumor sites included oropharynx (15/58), hypopharynx (12/58), pharynx (16/58), larynx (11/58), and unknown primary (4/58).

In his study, Dr. Jacobson stated that definitive treatment consisted of either concomitant chemoradiation (67.2%) or external beam radiation therapy (32.8%). In the monotherapy group, all patients received a total curative dose of 66 to 72 Gy in once-daily fractions of 180 to 200 cGy. The chemoradiation group received a similar radiation schedule and a four-day continuous infusion of cisplatin, 20 mg/m2/day and 5-fluorouracil, 1000 mg/m2/day. The infusions were given on the first and fourth weeks of radiotherapy. A planned selective neck dissection was performed on all the patients three to 12 weeks after completion of definitive medical therapy. CT scans of the neck were not routinely obtained prior to the staged neck dissection. All patients had a selective neck dissection encompassing levels II-IV. Following neck dissection, the median time of follow-up was 37 months (range 17-71 months).