The Role of Irradiation in the Management of Head and Neck Cancer: Analysis of Results and Causes of Failure

The records of patients with squamous cell carcinoma of the oral cavity, oropharynx, supraglottic and glottic larynx, whose primary lesion was treated with radiation therapy from 1964 through 1973, were reviewed. End points of the study are local control rate at the primary site, ultimate control with surgical salvage, and causes of failure. The local control rate at the primary site was 90% for T1 lesions, 80% for T2 lesions, and approximately 70% for selected T3 lesions. The control rates for the advanced T3 and T4 lesions are unsatisfactory; therefore, preoperative or postoperative irradiation is combined with appropriate surgical procedures to improve the local control rates and in some instances survival rates. Analysis of cervical node metastases treatment shows that the incidence of local recurrence in the radically dissected neck can be significantly reduced with either pre- or postoperative irradiation. Elective irradiation of initially clinically uninvolved areas of the neck (both ipsilateral and contralateral) has almost eliminated subsequent nodal metastases.