XLVI A Study of Central and Peripheral Biopsies in Combined Therapy of Head and Neck Cancer

Abstract

by invitation) SARKIS S. SARKISIAN, M.D. (by invitation)MONTCLAIR, NEW JERSEY Improved salvage rates in head and neck cancer by employment of pre-operative radiation therapy have brought this concept of treatment increasingly into use during the past decade. Coldmanl, Henschke'', MacComb3, and others have shown that long-term survival is enhanced, even though radiation dosage, and the interval between completion of radiation and time of surgery vary widely. Experience at the BlackStevenson Memorial Clinic of the Presbyterian Hospital in Newark supports these results, although controlled studies of comparable groups of cases are not available. This paper is the result of an effort to gain additional insight into the complex inter-relations of clinical behavior and the related histological response in head and neck cancer. In the hope of learning why combined therapy has improved salvage rates, we have studied the effect of cobalt radiation in serial biopsies of the central and peripheral portions of malignant tumors of the oral cavity.The immediate stimulus for our work was the observation that a line of resection closer to radiated tumor than planned did not necessarily result in local recurrence. On several occasions the necessity of preserving one lingual artery in resection of irradiated carcinoma of the base of the tongue has compelled the surgeon to reduce the margin of apparently healthy tissue around the tumor to an ordinarily unacceptable degree. Survival of these patients free of detectable disease well past the time when one might expect recurrence whetted our curiosity as to the behavior of tumor cells in the center and at the periphery of a lesion.