Small oropharyngeal
carcinomas with advanced neck
metastases (stage N2 or greater) are common. Patients with small T with large N oropharyngeal
carcinoma have high rates of local control but lower rates of regional control when treated with
chemoradiotherapy. Clinical assessment after
chemoradiotherapy cannot ensure the absence of neck disease. In the last 5 years, we have treated patients with T1-2 with N2-3 oropharyngeal
carcinoma with weekly
docetaxel radiotherapy followed by planned
neck dissection (PND). Our objectives were to clarify the pathologically complete response (CR) rate of neck
metastasis after weekly
docetaxel radiotherapy, to identify the clinical predictor of residual neck disease, and to determine the mobidity of planned
neck dissection. After
chemoradiotherapy, all 12 patients had a complete response at the primary site. We conducted 15
neck dissections. Of these, 6 (40%) had positive nodes. The pathological CR rate of neck
metastasis was 58.3%, whereas overall 2-year neck control rate was 91.7%. These findings lend support to the role of PND after
chemoradiotherapy in N2-3 neck disease. After
chemoradiotherapy, clinical parameters including TN status, feasibility of
chemoradiotherapy, largest lymph node size or size reduction in MRI, did not identify patients with residual neck disease. We conducted selective
neck dissection (SND) in 80% of patients. SNI) as PND appears to be appropriate in this group of patients because of the low incidence of complications. A further cohort study including the comparison of PND nonenforcement group is necessary to clarify the validity of the addition of PND in weekly
docetaxel radiotherapy.