Elective neck dissection for second primary after previous definitive radiotherapy ☆,☆☆ Aaron D. Falchook, MD, Roi Dagan, MD, Christopher G. Morris, MS, William M. Mendenhall, MD ⁎ Department of Radiation Oncology at the University of Florida College of Medicine, Gainesville, FL, USA Received 3 February 2011 Abstract Purpose: The aim of this study was to define the role of neck dissection during surgery for patients who have received elective nodal irradiation in the course of treatment for a prior squamous cell carcinoma of the head and neck (SCCHN) and are subsequently diagnosed with a second primary SCCHN. Materials and methods: We reviewed the medical records of 13 patients who received both definitive radiotherapy and elective nodal irradiation for T1-4 N0 M0 SCCHN of the oral cavity, oropharynx, hypopharynx, or larynx who then subsequently developed a metachronous T1-4 N0 M0 SCCHN primary at a new site. All second primary tumors were treated with surgery. Ten of the 13 patients also received an elective neck dissection (END) at that time: 7 unilateral and 3 bilateral. We report the outcomes for the patients in this series. Results: One (8%) of 13 neck dissection specimens was positive in 1 (10%) of 10 patients. The 5- year outcomes were the following: local-regional control, 67%; local control, 77%; disease-free survival, 62%; overall survival, 38%; and cause-specific survival rate, 77%. Six patients experienced treatment-related complications of grade 2 or higher (per Common Terminology Criteria for Adverse Events, version 4). Complications occurred exclusively in patients who received an END. Conclusions: The risk of occult nodal disease may be low enough to justify omitting an END for a second primary SCCHN in selected patients while maintaining treatment efficacy and reducing patient morbidity. Larger studies on this subject are needed to further address this question. © 2012 Elsevier Inc. All rights reserved. 1. Introduction The role of elective neck dissection (END) during resection of a second primary squamous cell carcinoma (SCCA) of the head and neck (SCCHN) in patients who have received elective nodal irradiation (ENI) for a previous SCCHN is ill defined. In this select group of patients, the risk of occult nodal disease may be low enough to omit END. Evidence shows that neck dissection in the treatment of SCCHN is significantly correlated with severe late toxicity [1]. In addition, recent studies suggest that there may be no benefit in performing END during salvage surgery for locally recurrent SCCHN in patients who have previously received radiotherapy (RT), with or without ENI [2,3]. Therefore, it is worthwhile to investigate the role of END in other selected patient populations. The patients examined in this small retrospective cohort presented with N0 SCCHN and received definitive RT to the primary site of the cancer as well as ENI. They then experienced a metachronous second primary N0 SCCHN at a new site some time after their initial therapy and received surgery with or without END. We investigated the role of END in this setting by analyzing the pathologic results of neck dissection as well as actuarial outcomes of disease control and patient survival to quantify the risk of occult Available online at www.sciencedirect.com American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 199 – 204 www.elsevier.com/locate/amjoto ☆ Financial disclosure: The authors have no financial disclosures. ☆☆ Conflicts of interest: The authors have no conflict of interest to disclose. ⁎ Corresponding author. 2000 SW Archer Rd., PO Box 100385, Gainesville, FL 32610-0385, USA. Tel.: +1 352 265 0287; fax: +1 352 265 0759. E-mail addresses: mendwm@shands.ufl.edu, kirwaj@shands.ufl.edu (W.M. Mendenhall). 0196-0709/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.amjoto.2011.04.009