Planned neck dissection after definitive radiotherapy for squamous cell carcinoma of the head and neck

Background. To define the role of planned neck dissection after definitive radiotherapy for patients with nodepositive squamous cell carcinoma of the head and neck. Methods. Review of the pertinent literature. Results. Radiotherapy alone produces a relatively high likelihood of regional control for patients with early-stage neck disease. Patients with more advanced neck disease have a higher probability of regional control if a planned neck dissection follows radiotherapy. However, for patients who have a complete response to radiotherapy, the likelihood of an isolated recurrence in the neck is low. Radiographic evaluation of the response to radiotherapy may better define the subset of patients who are likely to benefit from a neck dissection. Conclusions. Neck dissection after definitive radiotherapy improves regional control for patients with advanced neck disease. Patients who have a complete clinical and radiographic regional response to radiotherapy have a low probability of an isolated recurrence in the neck. It is advisable to proceed with a neck dissection for patients who have an equivocal response to radiotherapy, because the likelihood of salvage of an isolated recurrence in the neck is remote. (C) 2002 Wiley Periodicals, Inc.