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BIBTEX RIS

Treatment results on advanced neck metastasis (N3) from head and neck squamous carcinoma

2005; Wiley; Volume: 132; Issue: 6 Linguagem: Inglês

10.1016/j.otohns.2005.01.034

1097-6817

André Lopes Carvalho, Luiz Paulo Kowalski, Ivan Marcelo Gonçalves Agra, Everton Pontes, Olímpio Daniel de Campos, Antônio Cássio Assis Pellizzon,

Cancer Diagnosis and Treatment

OBJECTIVE To analyze the long‐term results of patients with N3 neck metastasis from squamous carcinoma of the head and neck. STUDY DESIGN This study is based on the analysis of a retrospective cohort of 224 previously untreated patients with squamous cell carcinoma of the head and neck and lymph node metastasis sized greater than 6 cm (N3) who were evaluated from 1981 to 1996. RESULTS Fifty‐four patients (24.1%) underwent neck dissection, 137 underwent radiotherapy alone (61.2%), and 33 received only supportive care (14.7%). Control of the neck metastasis was achieved in 46 cases among the treated ones (24.1%), varying from 51.9% for the patients who underwent surgery to 13.1% for radiotherapy alone ( P >0.001). Exclusive distant metastasis occurred in 37.0% of the cases who had control of the neck disease. The 3‐year overall survival rates were 17.9% for patients who underwent surgery and 7.0% for radiotherapy alone ( P = 0.003). The multivariate analysis showed as independent predictive factors the treatment approach ( P >0.001) and tumor site ( P = 0.016). CONCLUSIONS This study confirms the poor prognosis of patients with N3 neck disease, mainly when treated by radiotherapy alone. A radical neck dissection associated with adjuvant radiotherapy is indicated whenever feasible. Because of the high rate of distant metastasis, protocols including adjuvant chemotherapy should be investigated.