PMID- 18806474
OWN - NLM
STAT- MEDLINE
DCOM- 20081009
LR  - 20081001
IS  - 1531-4995 (Electronic)
IS  - 0023-852X (Linking)
VI  - 118
IP  - 10
DP  - 2008 Oct
TI  - Need for neck dissection after radiochemotherapy? A study of the French GETTEC 
      Group.
PG  - 1775-80
LID - 10.1097/MLG.0b013e31817f192a [doi]
AB  - BACKGROUND/HYPOTHESIS: The need for a neck dissection after radiochemotherapy 
      (RCT) for patients with unresectable cancer of the head and neck remains 
      questionable. We evaluated our strategy to perform a neck dissection in patients 
      with a controlled primary tumor based on the response to RCT according to 
      regional control, survival rates, and morbidity. STUDY DESIGN: The French "Groupe 
      d'Etude des Tumeurs de la Tete et du Cou" (GETTEC) group retrospectively 
      performed a multicenter review. One hundred and three stage III (N = 7) or IV (N 
      = 96) patients with unresectable primary tumors and node-positive disease and no 
      distant metastases treated between 1996 and 2002. Tumors were considered 
      unresectable or with poor surgical curability based on advanced stage, or 
      patients were surgically unfit for medical reasons. RESULTS: With a median 
      follow-up of 30 months, the complete clinical and radiological nodal response 
      rate was 61%. Among 39% (N = 40) of patients with residual neck disease, 70% (N = 
      28) underwent a neck dissection, whereas the remaining 30% either underwent 
      watchful follow-up for probable scary nodes, or were deemed unresectable or 
      medically unfit for surgery. Half of the neck dissection specimens showed 
      pathological evidence of viable tumor. Grade 3 to 4 complications were recorded 
      in four patients (14%) after neck dissection. Regional control was better for 
      complete responders. Disease-free survival and overall survival were similar 
      between patients with a complete response in the neck and no neck dissection, and 
      patients with a neck dissection for residual neck disease. CONCLUSIONS: The 
      strategy to avoid a neck dissection is safe in patients with a complete response 
      in the neck, regardless of initial nodal stage. In patients with residual neck 
      disease, postRCT neck dissection can be performed with limited morbidity. 
      Progress is warranted to optimize the pathological response in the nodes and to 
      better assess ambiguous nodal responses with multi-modal imaging.
FAU - Vedrine, Pierre-Olivier
AU  - Vedrine PO
AD  - Department of Otolaryngology-Head and Neck Surgery, Cannes Hospital, Cannes, 
      France.
FAU - Thariat, Juliette
AU  - Thariat J
FAU - Hitier, Martin
AU  - Hitier M
FAU - Janot, Francois
AU  - Janot F
FAU - Kaminsky, Marie-Christine
AU  - Kaminsky MC
FAU - Makeieff, Marc
AU  - Makeieff M
FAU - De Raucourt, Dominique
AU  - De Raucourt D
FAU - Lapeyre, Michel
AU  - Lapeyre M
FAU - Toussaint, Bruno
AU  - Toussaint B
CN  - French Groupe d'Etude des Tumeurs de la Tete et du Cou Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Laryngoscope
JT  - The Laryngoscope
JID - 8607378
SB  - IM
MH  - Adult
MH  - Aged
MH  - Combined Modality Therapy
MH  - Female
MH  - Head and Neck Neoplasms/mortality/pathology/*therapy
MH  - Humans
MH  - Lymphatic Metastasis
MH  - Male
MH  - Middle Aged
MH  - *Neck Dissection
MH  - Survival Rate
EDAT- 2008/09/23 09:00
MHDA- 2008/10/10 09:00
CRDT- 2008/09/23 09:00
PHST- 2008/09/23 09:00 [pubmed]
PHST- 2008/10/10 09:00 [medline]
PHST- 2008/09/23 09:00 [entrez]
AID - 10.1097/MLG.0b013e31817f192a [doi]
PST - ppublish
SO  - Laryngoscope. 2008 Oct;118(10):1775-80. doi: 10.1097/MLG.0b013e31817f192a.