Patterns of Cancer Recurrence in the Postoperatively Irradiated Neck

Abstract

\s=b\Data from 92 patients with stage III or IV squamous cell carcinoma of the head and neck treated with surgery and planned postoperative radiotherapy were analyzed to determine the incidence and patterns of tumor recurrence. Overall, recurrent tumor in the cervical region developed in 19 patients (21%). Of these, eight were in the neck alone and 11 in both the neck and the primary site. All recurrences were in the ipsilateral cervical region and none in the contralateral neck. The presence of two or more metastatic nodes at the time of surgery correlated with tumor recurrence and decreased survival. Extracapsular tumor spread increased the recurrence rate. Our data suggest that postoperative radiotherapy decreases ipsilateral cervical tumor recurrence in only those patients with more than two metastatic lymph nodes, and contralateral neck recurrence in all patients. (Arch Otolaryngol 1983;109:753-756) The extent of metastatic spread to cervical lymph nodes is an impor¬ tant prognostic indicator in patients with head and neck cancers. Studies correlating the clinical and pathologic characteristics of cervical lymph nodes have demonstrated that num¬ ber,1"4 position,3 and size of metastatic cervical lymph nodes5 and presence of extracapsular tumor spread6·7 ad¬ versely influence the treatment results. Combinations of surgery and preop¬ erative postoperative irradiation are used in attempts to improve the results obtained with only surgery or irradiation alone.810 Selected reports dealing with the use of preoperative irradiation and surgery in stages III and IV head and neck cancers indi¬ cated decreased cervical tumor recur¬ rence rates.3 8 However, errors in clini¬ cal staging of cervical node involve¬ ment,247 as well as a relative increase in postsurgical complications11 have led clinicians to favor the use of radi¬ ation therapy postoperatively. Anoth¬ er advantage attributed to postopera¬ tive irradiation over preoperative irradiation is the ability to identify patients at risk for tumor recurrence following the detailed study of surgi¬ cal specimens. Since 1976, we have adopted a policy of routinely using postoperative radiotherapy for patients with clinical stage III or IV squamous carcino¬ ma of head and neck sites. The ratio¬ nale for such a policy has been to decrease the tumor recurrence at the primary site and in the dissected and contralateral cervical regions. In this study, we assessed the effect of planned postoperative radiotherapy on the cervical tumor recurrence rate and drew conclusions providing guide¬ lines for future treatment protocols. METHODS Between 1976 and 1981, a total of 92 patients with resectable stage III or IV12 squamous carcinoma of the head and neck were treated with surgical resection and planned postoperative radiotherapy at the

Occult tonsillar carcinoma in the unknown primary

“…The presence of extracapsular spread has also been described as a significant prognostic indicator in patients with cervical metastases of unknown primary origin 22,23 . Although the current series supports this conclusion, the association between recurrence and extracapsular spread was not statistically significant for this group.…”

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

“…The high incidence of positive operative specimens in patients with multiple neck nodes denotes a poor prognosis for these patients. Combined treatment is recommended to obtain regional control ( 13,21), even if such a treatment only serves to change the pattern of recurrence and the cause of death.…”

Time factor and treatment strategies in subclinical disease

“…Some reports have not demonstrated a detrimental effect of prolonged T SPRT (Mantavardi et al 1983, Parsons et al 1997, Amdur et al 1998, while the others have (Schiff et al, Trotti et al 1998, Ang et al 2001, Pedraza et al 2001, Suwinski et al 2003. In addition, the importance of the position of radiation treatment gaps for local control in postoperative radiotherapy is, for the most part, unknown.…”