Management of advanced nodal disease following chemoradiation for head and neck squamous cell carcinoma: role of magnetic resonance imaging.

BACKGROUND The purpose of this study was to determine the role of magnetic resonance imaging (MRI) to predict persistent nodal disease in head and neck cancer treated with chemoradiation. METHODS Retrospective chart review of 38 patients with head and neck cancer and N2/N3 neck disease who were treated with chemoradiation and who had an MRI 6 to 8 weeks following treatment. RESULTS Sixteen patients had MRI findings suggestive of persistent nodal disease and were managed with neck dissections, three of whom had a persistent tumour. All of these patients have remained disease free in the neck (average follow-up 15 months). Among 22 patients without evidence of nodal disease on post-treatment MRI, 2 patients have had recurrence in the neck (average follow-up 26 months). CONCLUSIONS Concomitant chemoradiation is effective for the treatment of advanced nodal disease in selected patients. Patients without MRI evidence of persistent nodal disease following chemoradiation who were observed had a low incidence (9%) of eventual neck recurrence, whereas those with evidence of persistent nodes on MRI had a 19% likelihood of residual pathologic neck disease. The optimal strategy for the evaluation of the neck following chemoradiation requires further investigation.