Feasibility of selective salvage neck dissection (level II, III, IV) after primary radiotherapy of pharynx and larynx squamous cell carcinoma

Background Traditionally, radical or modified radical neck dissection was performed as salvage procedure in persistent or recurrent neck disease after primary radiotherapy. This relatively radical procedure has produced lots of morbidity to the survivors. Objective To assess the feasibility of selective or superselective neck dissection as used after primary radiotherapy Methods Retrospective cohort analyses of patients treated in the Netherland Cancer Institute –Antony van Leeuwenhoek (NKI-AVL) from 1995 until 2012. All patients with squamous cell carcinoma of oropharynx, hypopharynx and larynx who received primary radiotherapy and underwent salvage neck dissection were included. Results A total of 27 patients with 29 neck dissections were included. Microscopically, viable pathological lymph nodes were found in 59% (n=17) of the neck dissection specimens. In 10 of the 17 specimens the tumor positive level corresponded to the pre-treatment involved neck level. Single level of pathological lymph node involvement were found in 65% (n=11) of the specimens and 73% (n=8) of these were involved level II. In only 6% (n=1) that the pathological lymph node involved level I and level V. level IV was involved in 18% (n=3) of the neck dissection specimens and in the remaining 76% (n=13), the pathological lymph node confined to the level II and III. Conclusion In carefully selected cases, selective neck dissection (level II,III,IV) is safe to perform as salvage procedure in persistent or recurrent neck disease following primary radiotherapy for squamous cell carcinoma of the pharynx and larynx.