Hi --

I wanted to add a different perspective --neck dissections are not done routinely at some of the top CCCs now -- because some recent studies have shown a modest improvement in local control but no long-term survival advantage. Our MO (at Hopkins) says at that institution it is "controversial" -- and Sloan-Kettering bluntly told us they don't do them.

Hopkins uses fused PET/CT scans (much more accurate than PET or CT alone) at 3 months -- and again at 6 -- along with physical exams to determine response to treatment, and an increasing number of patients who show a complete clinical response are declining ND. I should add, however, that these scans are read by an expert who's seen 100's and 100's of HNC PET/CT scans and who can usually tell what's inflammation ans scarring and what's not -- whereas someone without this experience may only end up causing anxiety as they report lots of "uncertainty" and not help the situation (or your peace of mind) at all.

Neither my husband's MO, RO nor his ENT surgeon recommended a ND for him though the Hopkins surgeon (not his ENT but on his team) would probably have done one. He repeated what our RO said, about 5-10% improvement in local control. There are potential long-term problems associated with ND if not done by a surgeon with experience, you need to ask about what these could be and how they will ameliorate these issues. Ask how many NDs your surgeon has done and how well patients have done.

Many people report, as have the posters above, that the ND was the least of their problems in treatment. However all surgery involves risk, thus potential benefits and risks should be considered carefully.

Gail