Incidence of Subclinical Nodal Disease at the Time of Salvage Surgery for Locally Recurrent Head and Neck Cancer Initially Treated With Definitive Radiation Therapy

Objectives/Hypothesis:To estimate the incidence of subclinical nodal disease at the time of isolated local recurrence (LR) after chemoradiotherapy for an initially staged N0 head and neck squamous cell carcinoma. Methods:We retrospectively reviewed 44 patients who underwent salvage surgery with or without elective neck dissection (END) for an isolated LR between 1997 and 2010. The incidence of subclinical nodal disease was determined from the pathology reports and from clinical neck failures. Results:Thirty patients received END. The overall incidence of subclinical nodal disease in patients with dissected necks was 10% (3/30 patients). The rate of regional control for the 14 observed necks was 100%. Three-year local control and overall survival rates for the END and non-END cohorts were 71% versus 73% (P=0.80) and 55% versus 64%, respectively (P=0.40). Conclusions:The risk of subclinical nodal disease is low for patients with an isolated LR after chemoradiotherapy.