Multidisciplinary treatment of the neck

Since lymph node metastases are one of the most important prognostic factors, treatment of the neck is challenging. In clinically N0 neck, (super)selective neck dissection is indicated, whereas a more extensive neck dissection with preservation of important structures is performed in N2-N3 disease. Adjuvant treatment consists of radiotherapy with or without chemotherapy in patients with an intermediate or high risk of recurrence in the neck. Primary radiotherapy alone is effective in non-bulky disease. In more extensive neck disease, a combination of radiotherapy and chemotherapy with or without planned neck dissection is indicated. Advances in imaging and treatment as well as risk assessment have further modified the paradigm of planned neck dissection. Primary chemoradiation is effective for sterilising occult disease, and, therefore, post-treatment (super)selective neck dissection seems to be sufficient.