Upfront vs. no upfront neck dissection in primary head and neck cancer radio(chemo)therapy: Tumor control and late toxicity



      The benefit of upfront neck dissection (ND) in locally advanced head and neck squamous cell carcinoma (HNSCC) treated with primary (chemo-) radiotherapy (R(C)T) is debated. Therefore, we retrospectively compared disease control and toxicity between patients who were treated with and without upfront ND followed by R(C)T.


      Two-hundred sixty-four consecutive patients with HNSCC without distant metastases at diagnosis and with lymph node stage N2–N3 were included in 2 centers. Patients were all treated between January 2002 and December 2012, and received definitive R(C)T in center 1 and upfront ND followed by R(C)T in center 2. Clinical data and outcome were assessed retrospectively. Toxicity was scored using the LENT-SOMA scale at 6, 12, 18 and 24 months following the end of treatment.


      We included 150 patients in the group without ND (center 1) and 114 patients in the group with upfront ND (center 2).
      Mean follow up was 5.68 years in the group without ND and 5.83 years in the group with upfront ND. Local, regional and distant control after 2 years were 91.07% and 85.96% (p = 0.09), 89.22% and 83.27% (p = 0.12) and 76.74% and 75.13% (p = 0.92) in the group with and without upfront ND, respectively.
      We did not find a significant difference between both groups regarding edema and atrophy at 6, 12, 18 and 24 months. We found a trend at all time-points toward worse outcome in the ND group at all time-points (p = 0.06). A significantly higher proportion of moderate to severe fibrosis (grade ≥2) was present in the ND group (p = 0.01) at all time points.


      There was no significant difference in local, regional or distant control and disease-free survival between both patient populations. Fibrosis, specifically fibrosis grade ≥2 is more prominent following upfront ND and R(C)T when compared to R(C)T alone.


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