Pre versus Post-operative Radiotherapy of Resectable Squamous Cell Carcinoma of the Head and Neck

Abstract

The literature on pre-operative radiotherapy (RT) vs. post-operative RT in patients with advanced, resectable squamous cell carcinoma of the head and neck is reviewed and the theoretical arguments for and against the two different modalities discussed. It was possible to identify eleven reports published during the last four decades (1965-91) evaluating different aspects of pre- vs. post-operative RT given at comparable dose levels. Two reports were of prospective, randomised clinical studies and nine of retrospective comparisons. Together, the eleven studies comprised 1,358 patients (326 in prospective studies). The bulk of the evidence clearly suggests post-operative loco-regional control to be superior to pre-operative RT. However, this seems to be offset by the subsequent development of distant metastases or metachronous tumours.

Head and neck squamous cell carcinoma: The role of post‐operative adjuvant radiotherapy

“…There was a trend towards improved survival too, which was statistically non-significant. In a literature review involving 1,358 patients in 11 studies of preoperative versus PORT in advanced resectable HNSCC, Wennerberg [17] concluded that the bulk of evidence favored the postoperative arm. The only prospective randomized trial [4] comparing curative surgery with surgery plus PORT in patients with loco-regionally advanced HNSCC concluded that adjuvant radiotherapy does not improve outcome.…”

Malnutrition and food intake in relation to quality of life in head and neck cancer patients

“…There has also long been controversy about the optimal choice of treatment. [49][50][51] Survival and local control have traditionally been used as endpoints in clinical studies. We therefore suggest the use of a standardized self-assessment questionnaire to ascertain the QL of these patients as a complement to the traditionally used endpoints.…”

Preoperative concurrent chemoradiotherapy for stages II–IV oral squamous cell carcinoma: a retrospective analysis and the future possibility of this treatment strategy

“…In general, RT and chemotherapy are more effective in unaffected and welloxygenated tissue where the regional vasculature is intact, less hypoxic regions exist, and the drug delivery to the tumour may be better. For pre-and postoperative RT for advanced, resectable carcinoma of the head and neck, WENNERBERG 30 reviewed the literature and discussed the advantages and disadvantages of two different modalities. He showed that postoperative RT is to be preferred, as it yields better loco-regional control, and is probably associated with a lower frequency of complications, as well as avoiding the loss of important diagnostic information.…”