Neck dissection after chemoradiotherapy

Abstract

Chemoradiotherapy (CRT) is the basis of organ preservation treatment for laryngopharyngeal cancer. If one also considers induction chemotherapy, the timing of neck dissection varies. Thus, there are diverse approaches to neck management, including the indication and extent of neck dissection. We describe neck dissection after CRT from the point of view of the strategy as a part of multi-disciplinary treatment. The current mainstream is early salvage neck dissection, and the necessity or not of neck dissection is determined depending on the effect of the CRT. Therefore, the diagnosis of lymph node metastases is important to determine whether or not there is indeed a case of lymph node metastasis. The extent of neck dissection is tending to be reduced in order to minimize invasiveness and avoid complications. It is widely accepted that selective neck dissection is the current standard. Super-elective neck dissection is a new treatment strategy to reduce the extent of neck dissection even more. We also introduce the idea that up-front neck dissection is attracting attention again as a new treatment strategy.