eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Management of the N3 Neck: Follow-up

Author: Niels Kokot, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California
Coauthor(s): Gregory S Weinstein, MD, FACS, Professor and Vice-Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Director of Division of Head and Neck Surgery, Director of Head and Oncology Fellowship, Director of Otorhinolaryngology-Head and Neck Clinic, Co-director of The Center for Head and Neck Surgery, University of Pennsylvania School of Medicine
Contributor Information and Disclosures

Updated: Apr 8, 2009

Outcome and Prognosis

Outcomes are best when combined modality therapy is used. However, patients with the N3 neck have overall poor outcomes as a result of developing regional recurrence and distant metastases. Assessing the outcomes of the N3 neck is sometimes difficult because these patients frequently are grouped with patients with N2 neck disease.

Several recent studies have specifically addressed the outcomes of patients with N3 neck disease. Carvalho et al (2005) achieved the best regional control of 73% using surgery and postoperative radiotherapy, although overall 3-year survival was still poor at 17.9% in this group of patients.26 Chan et al (2003) also found the best results in the N3 patient by treating with surgery followed by radiation.25 Their 1-year, 3-year, and 5-year neck control rates in this group were 92.3%, 46.1%, and 46.1%, respectively. The overall disease free survival rates in their patients at 1, 3, and 5 years was 44.4%, 25%, and 22.2%, respectively.    

Ballonoff et al (2008) reported their results in patients with N3 neck disease treated with primary chemoradiation, with or without planned neck dissection.27 Their rates of locoregional control and distant control were 88% and 56%, respectively. Actuarial overall survival and disease-free survival at 2 years were 51% and 29%, respectively. 

Future and Controversies

The following methods for local control of recurrent tumor in the neck are currently under investigation:

  • Radiofrequency ablation28
  • Microwave interstitial hyperthermia (915 MHz)29,30
  • Intratumoral administration of cisplatin and epinephrine31
  • Interstitial photodynamic therapy32,33
  • Intratumoral administration of ONYX-015 adenovirus and chemotherapy34
  • Reirradiation therapy and chemotherapy with amifostine35
  • Electroporation with chemotherapy36

The role of PET with (18 F)-labeled fluorodeoxyglucose (PET-FDG) in predicting the necessity for postradiation or postchemoradiation therapy neck dissection in locally advanced head and neck squamous cell carcinoma that has completely responded to treatment is still being investigated. A large prospective randomized clinical study and longer follow-up is needed to determine whether FDG-PET will change local control, incidence of distance metastasis, and survival.

Selection criteria for planned neck dissection versus observation among patients who have had a complete response to chemoradiation therapy need to be established. Yao et al (2004) correlated residual pathology in postradiation or postchemoradiation neck specimens to the standard uptake value (SUV) in post-treatment FDG PET-CT scans.37 They found that an SUV of less than 3.0 had a negative predictive value of 100% and a positive predictive value of 80% for the residual tumor in the neck specimen.

Other authors have found that FDG PET-CT scanning adds little value over traditional CT scanning in determining who requires a postchemoradiation neck dissection for advanced neck disease.38 The exact role of FDG PET-CT is still unclear and requires further investigation.

 


More on Management of the N3 Neck

Overview: Management of the N3 Neck
Workup: Management of the N3 Neck
Treatment: Management of the N3 Neck
Follow-up: Management of the N3 Neck
Multimedia: Management of the N3 Neck
References
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Further Reading

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Keywords

neck disease, advanced neck disease, lymph nodes neck, n3 neck, neck cancer, squamous cell carcinoma, neck treatment, head neck cancer, cancer treatment, cancer management, SCCA, inoperable cancer of the neck, N3 disease of the neck, stage IV disease, tonsil cancer, cancer of the tonsil

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Contributor Information and Disclosures

Author

Niels Kokot, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California
Niels Kokot, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Gregory S Weinstein, MD, FACS, Professor and Vice-Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Director of Division of Head and Neck Surgery, Director of Head and Oncology Fellowship, Director of Otorhinolaryngology-Head and Neck Clinic, Co-director of The Center for Head and Neck Surgery, University of Pennsylvania School of Medicine
Gregory S Weinstein, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Radium Society, American Society for Head and Neck Surgery, Pennsylvania Medical Society, Philadelphia County Medical Society, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Medical Editor

William M Lydiatt, MD, Professor and Division Director, Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center
William M Lydiatt, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, and Nebraska Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Karen Hall Calhoun, MD, Professor, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University
Karen Hall Calhoun, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, Association for Research in Otolaryngology, Society of University Otolaryngologists-Head and Neck Surgeons, Southern Medical Association, Texas Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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