Neck Management and Postoperative Radiation Therapy for Head and Neck Cancers

Steven H. Lin and Vincent J. Lee

Background

What is a radical neck dissection?

Radical neck dissection is a procedure that removes all LN levels (“comprehensive”) from levels I–V and other structures (the sternocleidomastoid, jugular vein, spinal accessory nerve, omohyoid, and submandibular gland).

What is a modified radical neck dissection?

Modified radical neck dissection is a comprehensive nodal dissection that spares at least 1 of the following structures: sternocleidomastoid, jugular vein, spinal accessory nerve, or submandibular gland.

What is considered a selective neck dissection?

Selective neck dissection is dissection of selective neck areas based on the understanding of the common pathways of spread according to the H&N site.

What is a supraomohyoid neck dissection?

Supraomohyoid neck dissection is removal of nodes above the omohyoid muscle (level I–III and sup V), common for cancers of the oral cavity (OC).

What is a lat neck dissection?

Lateral neck dissection is elective dissection of levels II–IV, traditionally for cancers of the larynx and pharynx.

What is an anterolat neck dissection, and when should it be done?

Anterolat neck dissection is elective neck dissection of levels I–IV, typically done for cN0 oropharyngeal cancer (OPC).

What is an ant neck dissection, and when should it be done?

Ant neck dissection is selective neck dissection of levels II–IV, typically done for cN0 laryngeal/hypopharyngeal cancers.

What is a posterolat neck dissection, and when is it done?

Posterolat neck dissection is elective neck dissection of the retroauricular, suboccipital, upper jugular, and post cervical nodes. It is used for skin cancers (squamous cell carcinoma, melanoma) located post to the ear canal.

What is an ant compartment dissection, and when is it done?

Ant compartment dissection is selective level VI dissection, traditionally performed for thyroid cancers.

Workup/Staging

Which 3 H&N sites have the highest rates of clinical nodal positivity?

The nasopharynx (NPX) (87%), base of tongue (78%), and tonsil (76%) have the highest rates of clinical nodal positivity. (Lindberg R et al., Cancer 1972)

Which 2 H&N sites have the highest rates of retropharyngeal nodal positivity on CT/MRI?

On CT/MRI, nasopharyngeal and pharyngeal wall primaries

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