In the present study, we analyzed the impact of concurrent chemoradiotherapy (CCRT) statistically and reappraised the necessity of neck dissection (ND) in 32 cases of head and neck squamous cell carcinoma with N1 nodal disease.
At our hospital, between 1989 and 2005, we encountered 21 cases of N1 nodal disease in which the N-stage was not defined using PET-CT; the 3-year neck control ratio in these patients who were primarily treated by induction chemotherapy (ICT) followed by irradiation with ND or definitive irradiation alone, was 71%. On the other hand, between 2006 and 2014, we encountered 11 cases of N1 disease in which the N-stage was strictly defined using PET-CT; the 3-year neck control ratio in these patients treated by pre-operative CCRT followed by ND or definitive CCRT, was 100%. The difference between the two groups was statistically significant.
Furthermore, histopathological examination of the dissected lymph nodes from the patients treated by pre-operative CCRT revealed no evidence of residual disease.
Consequently, definitive CCRT without ND, if feasible, is a promising therapeutic strategy for N1 neck nodal disease, and although close follow-up with a “watch-and-see policy” and frequent examinations by FDG-PET are necessary.
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