Neck dissection in the management of regional metastases in patients with undifferentiated nasopharyngeal carcinomas |
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Authors: | I Pendjer A Mikić I Golubičić S Vučićević |
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Institution: | (1) Institute of Otolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Pasterova 2, YU-11040 Belgrade, Yugoslavia, YU;(2) National Cancer Institute of Serbia, Pasterova 14, YU-11040 Belgrade, Yugoslavia, YU |
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Abstract: | Residual regional disease after the primary treatment of nasopharyngeal carcinoma is still considered to be a therapeutic
problem. The limitations of prophylactic radical radiation, further doses of irradiation as a useful salvage procedure, and
the effects on vital structures were the reasons that we employed a therapeutic protocol consisting of radical neck dissection
after 40 Gy of radiotherapy and a full tumor dose after surgery. The initial treatment consisted of chemotherapy. Between
1977 and 1991 surgical removal of residual neck metastases was performed in 44 patients with undifferentiated nasopharyngeal
carcinomas who had regional metastases at the time of diagnosis. Fourteen patients (group A) had radical neck dissections
after initial chemotherapy (using doxorubicin, etoposide, bleomycin and/or 5-fluouracil) and between two courses of locoregional
radiotherapy. The remaining 30 patients (group B) were operated on after finishing chemotherapy and locoregional radiotherapy
(group B 1) or receiving only full-dose locoregional radiotherapy (group B 2). All patients had histopathologically proven
complete remission of primary tumors before neck surgery. The five-year survival rates for group A were 78%, 40% for group
B 1 and 27% for group B 2. There were statistically significant differences between groups A and B (P < 0.01), but not between groups B 1 and B 2. In group A one patient died from subsequent distant metastases and two from
local tumor recurrences. Twenty patients died in group B, regional relapses occurred in 40% of the patients in group B 1 and
33% in group B 2, while distant metastases developed in 40% of group B 2. These findings again showed that radical neck dissection
was an effective approach for controlling neck disease. When performed after initial chemotherapy and between two courses
of radiotherapy, surgery significantly improves the prognosis of patients with positive regional lymph nodes at the time of
diagnosis.
Received: 2 June 1998 / Accepted: 21 October 1998 |
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Keywords: | Undifferentiated nasopharyngeal carcinoma Residual regional lymph nodes Radiotherapy Chemotherapy Neck dissection |
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