Treatment with preoperative irradiation and surgery of squamous cell carcinoma of the head and neck

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Abstract
This is an analysis of 103 patients with squamous cell carcinoma of the head and neck treated with preoperative radiation therapy (4000–6143 cGy; mean 4980 cGy) followed by primary resection and neck dissection. Patients were treated between March 1965 and April 1985; there was a minimum 2‐year follow‐up. Most of the patients in this study had clinical Stage III (28%) or IV (68%) disease. The actuarial survival rates were 51.5% at 2 years, 31.4% at 5 years, and 18.9% at 10 years. The rates of disease control above the clavicles at 5 years (actuarial method) as a function of modified AJCC stage were as follows: 100% for Stage II, 70.5% for Stage III, 44.8% for Stage IVA, and 45.7% for Stage IVB. T stage, N stage, neck node status (number, size, and fixation), and the pathology of the surgical specimen (tumor in the specimen, surgical margin positive, number of metastatic nodes, and presence of extracapsular extension) were important prognostic factors. The interval, between radiotherapy and surgery, and primary site (oral cavity vs. other sites) were not important prognostic factors. The rate of moderate‐to‐severe complications was 33.9% including eight patients who developed lethal complications after treatment. The influence of the radiation course, dose, and other factors on control of disease above the clavicles and on complications is presented.