• L E Smeele, C R Leemans, J A Langendijk, R Tiwari, B J Slotman, I van Der Waal, and G B Snow.
• Department of Oral and Maxillofacial Surgery/Oral Pathology, University Hospital Vrije Universiteit/ACTA, PO Box 7057, NL-1007 MB Amsterdam, The Netherlands.
• Head Neck. 2000 Sep 1; 22 (6): 559-63.

BackgroundTo evaluate the outcome after surgery and radiotherapy for extensive nodal disease in patients with primary head and neck cancer.MethodsBetween 1973 and 1995, 77 from a total of 1398 patients had histopathologic evidence of positive margins in 85 neck dissection specimens for squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx. Postoperative radiotherapy with a curative dose was given to 50 necks. Ipsilateral neck recurrence was defined as the relevant event, and cumulative survival distributions were estimated by the Kaplan-Meier method. Differences between groups were analyzed with the log rank test.ResultsDisease-free survival was 24.9% at 2 years, and disease-specific survival was 33.6% at 2 years. After restriction of the 50 patients who received postoperative curative radiotherapy, the time to neck recurrence was stratified according to irradiation dosage, with 62.5 Gy as the cutoff point. A statistically significant difference was found for patients treated with 62.5 Gy or more, with a regional control rate of 75.6% at 2 years (p <.036).ConclusionsThe overall outcome after neck dissection with positive surgical margins is poor. Considerable improvement is achieved by postoperative radiotherapy treatment with dosages of 62.5 Gy or more.

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