Neck dissection after chemoradiation for carcinoma of the upper aerodigestive tract: indications and complications

Abstract

Purpose of review: Chemoradiation has become a common approach in the treatment of advanced head and neck cancer. Its effectiveness in eradicating associated nodal metastases has resulted in modifications in the traditional paradigms for managing this aspect.

Recent findings: Regardless of the pretreatment neck staging, patients who have a complete response to chemoradiation are unlikely to have residual viable tumor in this region, thus putting in question the need for planned neck dissection. F-Fluorodeoxyglucose positron emission tomography/computed tomography has become a standard tool to assess disease response to chemoradiotherapy, including the associated nodal disease. However, there remains an ongoing debate about its timing. The extent of neck dissection is trending toward an approach for selective procedures in order to minimize the long-term sequelae of extensive neck fibrosis.

Summary: Post-chemoradiotherapy neck dissection is an effective procedure for selected patients with advanced head and neck cancer but is becoming a less needed intervention.