Radiographic complete response on post treatment CT imaging eliminates the need for adjuvant neck dissection after treatment for node positive head and neck cancer.

Objective: The primary purpose of this study was to correlate radiographic response in the neck to clinical outcomes for patients with node positive head and neck cancer.

Methods: One hundred three patients with stage III/IV node positive cancer were treated with definitive radiotherapy or chemoradiation at a single institution from 1990 to 2004. Follow-up ranged from 8 months to 144 months with a median of 42 months. Posttreatment CT scans were called complete radiographic response (rCR) or partial radiographic response.

Results: Actuarial 36 month rates of survival, control above the clavicles, and nodal control were 66%, 74%, and 90%, respectively. Patients, who had rCR on posttreatment CT scan, who had a neck dissection had a nodal control rate of 94% compared with those without neck dissection of 97%. Patients with partial radiographic response who were treated with neck dissection had a nodal control rate of 94% compared with those without neck dissection of 73%.

Conclusions: Based on this data, there was no suggestion that neck dissection improved outcome for patients with rCR on posttreatment imaging 4 to 6 weeks after radiation.