Neck Dissection After Chemoradiotherapy

Abstract

Neck management after chemoradiotherapy (CRT) for head and neck cancer has become a controversial topic. At most institutions, planned neck dissections (NDs) after CRT are often no longer routinely performed.1-3 Rather, the neck is assessed and, if findings suggest possible residual metastatic disease, ND is advised. Results of early neck dual-modality positron emission tomography/computed tomography (PET/CT) may be inaccurate owing to treatment-related inflammation, cancer in evolution toward death, and pockets of residual disease that are too small to detect on imaging.4,5 Several investigators have found improved accuracy when PET/CT is delayed until 3 months or more after treatment.1-3,6 However, this time frame has conflicted with the traditional thinking that posttreatment ND should be performed within 4 to 12 weeks after radiation to lessen the risk of surgical complications.7