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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Carcinoma, Squamous Cell, Female, Head and Neck Neoplasms, Humans, Lymphatic Metastasis, Male, Middle Aged, Multivariate Analysis, Neck Dissection, Neoplasm Recurrence, Local, Prognosis, Radiotherapy Dosage.
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Does treatment result on advanced neck metastasis ( N3 ) from head and neck squamous carcinoma? Context: To analyze the long-term results of patients with N3 neck metastasis from squamous carcinoma of the head and neck. This study is based on the analysis of a retrospective cohort of 224 previously untreated patients with squamous cell carcinoma of the head and neck and lymph node metastasis sized greater than 6 cm (N3) who were evaluated from 1981 to 1996. Fifty-four patients (24.1%) underwent neck dissection, 137 underwent radiotherapy alone (61.2%), and 33 received only supportive care (14.7%). Control of the neck metastasis was achieved in 46 cases among the treated ones (24.1%), varying from 51.9% for the patients who underwent surgery to 13.1% for radiotherapy alone ( P < 0.001). Exclusive distant metastasis occurred in 37.0% of the cases who had control of the neck disease. The 3-year overall survival rates were 17.9% for patients who underwent surgery and 7.0% for radiotherapy alone ( P = 0.003). The multivariate analysis showed as independent predictive factors the treatment approach ( P < 0.001) and tumor site ( P = 0.016).
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This study confirms the poor prognosis of patients with N3 neck disease, mainly when treated by radiotherapy alone. A radical neck dissection associated with adjuvant radiotherapy is indicated whenever feasible. Because of the high rate of distant metastasis, protocols including adjuvant chemotherapy should be investigated. Final Decision: yes