ORIGINAL ARTICLE PATTERNS OF FAILURE AMONG PATIENTS WITH SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK WHO OBTAIN A COMPLETE RESPONSE TO CHEMORADIOTHERAPY Susannah Yovino, MD, 1 Kathleen Settle, MD, 1 Rodney Taylor, MD, 2 Jeffrey Wolf, MD, 2 Young Kwok, MD, 1 Kevin Cullen, MD, 3 Robert Ord, MD, DDS, 4 Ann Zimrin, MD, 3 Scott Strome, MD, 2 Mohan Suntharalingam, MD 1 1 Department of Radiation Oncology, Marlene and Stewart Greenebaum Cancer Center, University of Maryland Medical System, Baltimore, Maryland 21201. E-mail: msuntha@umm.edu 2 Department of Otorhinolaryngology, Marlene and Stewart Greenebaum Cancer Center, University of Maryland Medical System, Baltimore, Maryland 21201 3 Department of Medical Oncology, Marlene and Stewart Greenebaum Cancer Center, University of Maryland Medical System, Baltimore, Maryland 21201 4 Department of Oral/Maxillofacial Surgery, Marlene and Stewart Greenebaum Cancer Center, University of Maryland Medical System, Baltimore, Maryland 21201 Accepted 12 March 2009 Published online 29 May 2009 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.21141 Abstract: Background. The role of adjuvant neck dissec- tion in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) who obtain complete clinical and radiologic response following definitive chemoradiation treatment is controversial. Methods. Patterns of failure among 120 patients with locally advanced SCCHN, all with node-positive disease, treated with concurrent chemoradiation, were analyzed. Results. Ninety-one of the patients achieved a complete response and were observed without undergoing neck dissec- tion. Isolated failure in the neck occurred in 2 patients. The most common site of failure was metastatic disease (17 patients). Six patients had recurrence at the primary only, and 1 experienced failure in the neck and at the primary. Partial responders with resectable disease underwent neck dissection following chemoradiation. This group had worse local control and overall survival compared with complete responders. Conclusions. We recommend observation after definitive chemoradiation for complete responders. Further research is needed to improve outcomes among partial responders. V V C 2009 Wiley Periodicals, Inc. Head Neck 32: 46–52, 2010 Keywords: head and neck cancer; chemoradiation; neck dissection Head and neck oncologists have long debated the role of planned neck dissection in patients with locally advanced squamous cell cancer of the head and neck (SCCHN). Proponents of performing neck dissection following definitive chemoradiation argue that clinical examination is unreliable in determining whether or not a patient has truly obtained a complete response (ie, 100% cell kill) to chemoradiation, and that Correspondence to: M. Suntharalingam This work was presented at the 49th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Los Angeles, Califor- nia, 2007. V V C 2009 Wiley Periodicals, Inc. 46 Patterns of Failure in SCCHN Complete Responders HEAD & NECK—DOI 10.1002/hed January 2010