Per both our radiation onc and our ENT, neck dissection adds about 5-10% locoregional control, but it has more difficult to demonstrate long-term survivorship benefts. The current thinking seems to be that a certain subset of patients, which includes those with extensive disease and those whose post-treatment scans do not indicate a complete clinical response to chemoradiation (the standard treatment), can benefit. However demonstrated negative side-effects, many of which can be long-term (or even permanent) are making some oncologists question the routine use of this procedure in all patients.

In fact, it is, per our MO, "falling out of favor" and is not used, for example, at some top CCCs such as Sloan-Kettering. At Hopkins, where my husband was treated, many patients decline ND and the percentage is increasing.

It is also becoming recognized that a majority of tonsillar cancers are due to human papilloma virus, and of these, about 90% to HPV-16. The low recurrence rate and higher surivorship associated with HPV-16 positive head and neck cancer which has (based on post-treatment exams) responded successfully to chemoradiation may also make additional surgery less necessary. (Fakhry & Gillison, 2006; Gillison 2006, both J. Clin. Onc.)

Finally, the standard protocol at most CCCs is that ND follows chemoradiation, and the planning of the surgery is based on results from treatment and most-treatment scans and physical exams.

Gail