Management Implications of Evaluating the N2 and N3 Neck After Organ Preservation Therapy

Objectives/Hypothesis: To determine if metastatic squamous cell carcinoma with proliferative potential persists in N2 and N3 necks after conventional radiation. Study Design: Retrospective case series. Materials and Methods: We identified 17 patients from our head and neck tumor database who underwent organ‐preserving radiotherapy for primary aerodigestive squamous cell cancer and N2‐3 regional metastasis. Archival tissue from these 17 neck specimens was evaluated for routine histopathologic evidence of tumor, as well as immunohistochemically for cytokeratin and Ki‐67 activity. An assay for apoptosis was also performed on 10 of the specimens. Results: Routine H&E evaluation suggested metastatic cancer in 11 of 17 irradiated neck specimens. Cytokeratin immunostaining confirmed squamous cell carcinoma in these 11 necks as well as 1 additional specimen that had tested H&E negative. Ki‐67 staining demonstrated proliferating tumor in 3 of 17 necks. The apoptosis assay confirmed regions of apoptosis in all of the specimens analyzed. Conclusions: The discovery of proliferating cancer cells in 3 of 17 irradiated specimens (18%) supports the practice of planned neck dissection after primary radiotherapy for patients with pretherapeutic N2+ metastatic disease.