Postoperative Radiotherapy for Persistent Tumor at the Surgical Margin in Head and Neck Cancers

Abstract

Seventy-two patients with a carcinoma of the head and neck, who were treated with surgery and postoperative irradiation, were reviewed to determine the local recurrence rates and survival in patients with inadequate surgical margins. Tumor recurrence rate was 31% for patients with microscopic tumors at resection margins and 50% for those with macroscopic tumor. Actuarial 3-year survival for these patients was 71% and 43%, respectively. All 4 patients who were irradiated later than 6 weeks after surgery developed recurrent malignancy despite the resection margins being free of tumor. Excluding these patients the 3-year survival for R0 patients was similar to that of R1 patients. It is concluded that postoperative irradiation is effective in patients with tumor at the surgical margins. It is suggested that the time interval between surgery and radiation therapy be limited to less than 6 weeks. Radiation dose prescriptions for various clinical situations are discussed.

Risk factors for locoregional relapse after transoral robotic surgery for human papillomavirus–related oropharyngeal squamous cell carcinoma

“…Perineural invasion (PNI), lymphovascular invasion, T3 to T4 disease, or N2 disease are considered intermediate‐risk factors and adjuvant RT alone is typically offered to patients with these findings. Positive margins or extracapsular extension (ECE) are considered high‐risk factors and adjuvant chemoradiotherapy (CRT) has a demonstrated survival benefit compared to RT alone in this population …”

Complicações bucais da radioterapia em cabeça e pescoço

“…Surgery and radiotherapy are the treatment options for the localized or regional disease. 3,4 Many patients with head and neck cancer are submitted to high doses of radiotherapy in large areas including oral cavity, maxilla, mandible and salivary glands. Despite having the advantage of preserving the tissue structure, radiotherapy causes many adverse reactions in the oral cavity.…”

Radical Surgery and Postoperative Split-Course Radiotherapy in Squamous Cell Carcinoma of the Head and Neck—Factors Influencing Local Control and Survival

“…Delaying the initiation of irradiation beyond 6 weeks after operation increases the recurrence rate (10,23). It has been suggested that the time interval between surgery and radiation therapy be less than 6 weeks (lo), or that irradiation should begin as soon as healing is adequate ( I ) .…”