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.