The current thinking is that patients with a complete clinical response after chemoradiation may not benefit from neck dissection, that is, ND should be an option but not a routine procedure after treatment. This is rather a turn-around from where thinking was even when my husband was diagnosed (in June 2005) but reflects recent studies showing only modest local control benefit and no long-term survival benefits to ND in most classes of patients.

However, it should be emphasized that this means patients having an apparent clean scans and exams after treatment, and also, being closely monitored for the next few years. Also, for some ENTs (including my husband's) whether the patient was a smoker or not is important as this affects risk of recurrence. Since recurrence usually appears in the neck lymph nodes (per our MO and ENT), a post-treatment ND might be the prudent course of action for these patients.

However, our MO, RO and ENT now say that they would no longer recommend a ND for an HPV+ head and neck cancer that has responded completely to chemoradiation, as risks outweigh benefits. But if the outcome of treatment is uncertain, or if there is apparent residual disease, then a ND would be the prudent action.

Max -- tonsil cancer is actually increasing at a rate greater than that of oral cancer per se, according to Dr. Mara Gillison who is studying the role of HPV in oral cancer. She recently wrote that tonsil cancer may well be considered a "surrogate" for HPV+ cancer. Anyone with a tonsillar cancer should get the tumor tested for HPV, since it is a biologically different beast and responds differently to treatment than does HPV- cancer. Has a better prognosis as well.

Gail