Author: Mary Beth Nierengarten

Selective neck dissection, rather than comprehensive neck dissection, is an effective treatment for many patients with regional nodal metastases from head and neck squamous cell carcinoma, investigators reported here at the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) 2008 Annual Meeting & OTO EXPO.

Lead author Peter Shepard, MD, Department of Surgery, University of Wisconsin School of Medicine, Madison, Wisconsin, presented the study findings in a poster session on September 21.

In their study, Dr. Shepard and colleagues retrospectively evaluated 156 patients with clinically-positive regional nodal metastases from head and neck squamous cell carcinoma in whom neck dissection was part of the initial treatment. Of the 156 patients, 69 underwent selective neck dissection (SND) and 87 underwent radical or modified radical neck dissection (R/MRND). Most patients (81%) also received postoperative radiotherapy.

Overall, regional recurrences occurred in 8.6% of patients who underwent SND and 22% of patients who underwent R/MRND.

When adjusting for differences in nodal and primary tumour stage, year of surgery, primary tumour site, extracapsular spread, and postoperative radiotherapy, multivariate analysis showed a significantly lower regional recurrence rate in the SND group (P = .02).

No statistically significant differences were seen in overall survival; 5-year overall survival for SND and R/MRND of 47% and 33%, respectively (P = .14). Similarly, no significant differences were found in local control or distant local control, with 3-year local control rates of 87% and 83% (P = .89) and distant control rates of 79% and 74% (P = .30).

Although Dr. Shepard said the study is limited by the lack of randomisation as well as differences in group characteristics, he emphasised that these differences were adjusted for by performing a multivariate analysis.

Despite these limitations, Dr. Shepard said that “selective neck dissection is an effective treatment for a wide variety of patients with clinical regional nodal metastasis staged N1 or N2.”

He also pointed out that although most centres usually perform selective neck dissections, “the current National Comprehensive Cancer Network guidelines still list comprehensive neck dissections as the surgical treatment of choice in the setting of regional nodal metastases.”

“Our study demonstrates that patients who underwent selective neck dissection for clinically positive, regional nodal metastasis of head and neck squamous cell carcinoma had a low regional recurrence rate that was better than those who underwent comprehensive neck dissection,” Dr. Shepard concluded. “None of the regional recurrences were in a level that was preserved or would have been included in a comprehensive neck dissection.”

1. Presentation title: Therapeutic Selective Neck Dissection Outcomes. Poster S174
2. presented at the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) 2008 Annual Meeting, Chicago, IL