PLANNED NECK DISSECTION AFTER RT

HISTORICAL FACTS

• HISTORICALLY, for years these patients have been managed with moderate dose external beam radiation therapy followed by a planned neck dissection at the University of Florida based on the historically documented high rate of persistent or recurrent disease with radiation therapy alone or surgery alone.
• NOW, patients with N2-N3 neck disease that have a complete clinical and imaging (CT, MRI, PET) response to radiation therapy or radiation therapy and chemotherapy rarely fail in the neck as an isolated site of treatment failure

PLANNED NECK DISSECTION

• MODERATE DOSE of radiation
  • spare the larynx from unnecessary irradiation
  • reduce the risk for postoperative complications.

NOT PLANNING NECK DISSECTION

• Avoidance of neck dissection
• Need to radiate neck to HIGH-DOSE
• Occasional need to dissect heavily irradiated neck, if clinically or PET positive.

Bibliography

1. Mendenhall WM, Villaret DB, Amdur RJ, Hinerman RW, Mancuso AA. Planned neck dissection after definitive radiotherapy for squamous cell carcinoma of the head and neck. Head Neck. 2002 Nov;24(11): 1012-8.