Neck level-specific nodal metastases in XXXX : is there a role for selective neck dissection after definitive radiation therapy?

@entity1 @entity3329 @entity135 @entity82 @entity66 @entity5 @entity189
PURPOSE: To determine the extent of the required neck dissection for @entity1 with persistent @entity3329 after definitive radiation therapy for @entity5 . If feasible, a conservative approach using selective neck dissection would likely minimize the extent of neck @entity82 and other adverse sequelae. METHODS: Analysis of pretreatment and posttreatment radiologic scans and pathology reports of 76 @entity1 with @entity189 (35 tonsil; 41 base of tongue), who had radiologic evidence of persistent @entity66 for level-specific involvement. @entity1 were treated with twice-daily fractionations of external-beam radiation therapy (median dose, 76.8 Gy to the @entity5 ) and planned neck dissection (levels I-V) for bulky nodes (N2-3) or salvage neck dissection for N1 disease. RESULTS: The distribution of clinical @entity66 by neck level on the basis of pretreatment and posttreatment radiologic scans indicated levels II and III to be most commonly involved. The false-negative rate for the restaging radiologic scans for each neck level was as follows: level I, 0%; level II, 8%; level III, 6%; level IV, 5%; and level V, 1.5%. Of the eight hemi-necks found to contain positive pathologic nodes in a neck level judged to be negative on the basis of restaging scans, five of the @entity1 subsequently had disease recurrence in the primary site. @entity1 who had evidence of @entity135 had a significantly lower rate of locoregional control (77% vs 100%, p =.0005). CONCLUSIONS: The extent of neck dissection for @entity1 with @entity66 associated with @entity5 treated with radiation therapy should include levels II-IV. It is reasonable to spare levels I and V in @entity1 without radiologic and clinical evidence of positive nodes in levels I and V.
