Well, our medical onc and radiation onc both said that after an apparent complete clinical response, based on a PET/CT scan given no sooner than 3 months after end of treatment, that a ND can add 5-10% local control but recent studies have shown no long-term survival advantage (and more negative side effects). In case of suspicious scans or apparent residual disease, then an MRI and/or biopsy would be the next step, and if these were still suspicious, then a ND.
My husband had a tonsillar, base-of-tongue (and 2 nodes) SCC which was human papilloma virus-16 positive (many tonsillar tumors are, but not all) -- he had 33x radiation treatments and 7x chemo (carboplatin), has what was determined to be a complete clinical response and they told him a ND would probably not add anything more. Of course the Hpokins ENT would have liked to have done one, but he too acknowledged the figures I quoted above. Because of the potential long-term negative side effects my husband declined any further surgery. He is over a year out of treatment and everyone now (including his ENT) thinks he made the right decision. It was his decision, too, no one tried to "scare" him into surgery.
Sloan-Kettering, #1 CCC, does not do ND if the chemoradiation has achieved an apparent successful result, as they do not feel it adds anything. If a ND were the difference between success and failure of treatment, I cannot imagine they would forgo this step. Hopkins, where my husband was treated, still does them but our MO says they are "controversial" in the HNC service. A ND is not guaranteed to get rid of all the cancer, in any case -- if it did no one who has had one would have a recurrence. Unfortunately, this is not so.
The non-Hopkins ENT who did my husband's tonsillectomy and d'xed his cancer (she herself had HNC as a younger woman) said quite bluntly that doing extensive surgery with potential permanent side effects just to "see" if a cancer is gone (or appears to be gone, depends on how good the pathologist is!) is not an adequate reason to do it. She may be a minority voice, but she has been down the HNC road and most ENTs have not.
Gail
