Neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy

Background. The role of neck surgery in node-positive patients whose primary tumors are treated by definitive radiotherapy is controversial. This analysis was undertaken to assess the risk of withholding planned neck dissection in patients who obtain a complete nodal response to irradiation. Methods. We reviewed the records of 100 patients who presented between 1984 and 1993 with oropharyngeal cancers metastatic to the neck and whose primary tumors were treated by radiotherapy using the concomitant boost regimen. Seventy-five patients had their nodal disease treated definitively by radiotherapy; those who had complete clinical resolution of all nodal disease (62) had no planned surgery, while 13 underwent neck dissection for presumed residual disease. The remaining 25 patients had either node excision (8) or neck dissection (17) prior to radiotherapy. Results. There were 8 cases of isolated neck failure of which 3 occurred in the 62 patients who had no planned neck surgery, 0 in the 13 patients who had surgery for presumed residual (pathologically negative in 7), and 5 in the 25 patients who had initial neck surgery. In those who obtained a complete response to definitive radiotherapy, the risk of neck relapse was unrelated to pretreatment nodal size. Conclusions. The policy of observation of the neck after complete nodal response to full-dose irradiation is both safe and cost effective. Imaging to confirm the resolution of nodal disease is recommended.