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Neck dissection after chemoradiotherapy for oropharyngeal and hypopharyngeal cancer: the correlation between cervical lymph node metastasis and prognosis

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Abstract

Background

Recently, the role of chemoradiotherapy (CRT) for preserving organs in the treatment of head and neck cancer has been increasing. However, the indication for post-CRT neck dissection (ND) and its surgical extent is still controversial. The purpose of this study was to discuss the indications for post-CRT ND and the proper extent of the surgical procedure.

Methods

We performed a retrospective analysis on N2–3 oropharyngeal and hypopharyngeal squamous cell carcinoma (OHSCC) patients treated with CRT in our institute from 1995 to 2008, and determined the prognostic impact of post-CRT ND and the distribution of cervical lymph node (CLN) metastasis based on the pathological results of ND.

Results

The patients without pathological CLN metastases had good prognoses, whereas patients with pathological CLN metastases exhibited a significantly high recurrence rate (P = 0.033). Based on the pathological results of ND, performing selective ND at levels II–IV can contain 88 and 85 % of CLN metastasis of the oropharynx and hypopharynx, respectively. In all cases, when pathological CLN metastases were found at level V in ND following CRT, distant metastases developed.

Conclusions

The presence of pathological CLN metastasis affects prognosis, but also a diffuse distribution of CLN metastasis worsens prognosis; that is, the presence of CLN metastasis at level V after CRT appears to be an indicator of distant metastasis. Post-CRT ND may not make sense as a salvage intervention for improving the prognosis in such situations. We concluded that the proper extent of post-CRT ND of OHSCC is selective ND including levels II–IV.

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Acknowledgments

This work was supported by a Health and Labour Sciences Research Grant for Clinical Cancer Research (H20-Gannrinshou-Ippan-014) from the Ministry of Health, Labour and Welfare, Japan.

Conflict of interest

No author has any conflict of interest.

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Authors and Affiliations

  1. Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan

    Nobuhiro Hanai, Taijiro Ozawa, Hitoshi Hirakawa & Yasuhisa Hasegawa

  2. Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan

    Daisuke Kawakita

  3. Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan

    Takeshi Kodaira

Authors
  1. Nobuhiro Hanai
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  2. Daisuke Kawakita
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  3. Taijiro Ozawa
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  4. Hitoshi Hirakawa
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  5. Takeshi Kodaira
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  6. Yasuhisa Hasegawa
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Correspondence to Yasuhisa Hasegawa.

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Hanai, N., Kawakita, D., Ozawa, T. et al. Neck dissection after chemoradiotherapy for oropharyngeal and hypopharyngeal cancer: the correlation between cervical lymph node metastasis and prognosis. Int J Clin Oncol 19, 30–37 (2014). https://doi.org/10.1007/s10147-013-0518-9

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  • DOI: https://doi.org/10.1007/s10147-013-0518-9

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