Combined radiation therapy and surgery in the management of advanced head and neck cancer: Final report of study 73–03 of the radiation therapy oncology group

Abstract

Between March 1973 and June 1979, patients with advanced operable squamous cell carcinoma of the supraglottic larynx or hypopharynx were randomly allocated to receive either preoperative radiation therapy (5,000 rad) or postoperative radiation therapy (6,000 rad). Patients with oral cavity or oropharynx lesions were randomly assigned either preoperative radiation, postoperative radiation, or definitive radiation therapy (6,500-7,000 rad), with surgery reserved for salvage if residual disease was present 6 weeks after completion of irradiation. Three hundred twenty patients were evaluable with a median follow-up of 60 months. Based on results in 277 patients across all four regions combined, locoregional control was significantly better for patients assigned to receive postoperative radiation therapy (65%) compared with those assigned to receive preoperative radiation therapy (48%, P = 0.04). This was due to a higher rate of both persistent and recurrent local and regional disease in the preoperative group. Survival also showed a trend to be better in the postoperative group (38%) compared with the preoperative group (33%, P = 0.10). Rates of severe surgical and radiation therapy complications were similar overall. Forty-three patients were evaluable for each of the three treatment regimens assigned to patients with oral cavity or oropharynx lesions. Due to the small number of patients available for this portion of the trial, the observed differences for overall survival (4-year percentage 33% overall; 30% preoperative, 36% postoperative, 33% definitive radiation therapy) and for locoregional control (45% overall; 43% preoperative, 52% postoperative, 38% definitive radiation therapy) were not statistically significant. The use of definitive radiation therapy with surgical rescue as an ethically justified alternative treatment for these tumors remains a question for further research.

Treatment of Squamous Cell Carcinoma of the Oral Cavity, Oropharynx and Hypopharynx An Analysis of 174 Patients in South Western Finland

“…An expected complication from other studies among patients treated with irradiation (dose range 60 Á/66 Gy) was osteoradionecrosis (2.8%); the other major complications occurred in 7% among the patients treated with curative intent including surgery (29,30).…”

Combined Radiotherapy and Surgery in the Treatment of Neck Node Metastases from Squamous Cell Carcinoma of the Head and Neck

“…Whether surgery should be performed before or after radiotherapy is still being debated. The only randomized trial we are aware of compared 50Gy pre-and 60Gy postoperatively (24). This study showed a significantly higher rate of regional and local control in those receiving postoperative radiotherapy.…”

Manejo del cáncer de cabeza y cuello: ¿Radioterapia a quién, cuándo y por qué?

“…El único ensayo clínico aleatorizado en la literatura incluyó 70 pacientes con cáncer orofaríngeo tratados con RT (24 pacientes), RT neoadyuvante y cirugía (23 pacientes) o cirugía y radioterapia adyuvante (23 pacientes) sin encontrar diferencias significativas en los resultados 18 .…”