NODAL FAILURES IN PATIENTS WITH NO N-CELL CARCINOMA WITHOUT CAPSULAR RUPTURE( ORAL SQUAMOUS)

Background. The efficacy of postoperative irradiation of the neck afte r lymph node dissection in terms of prevention of cervical node recurr ence (NR) has not been demonstrated in patients with NO squamous cell carcinoma of the oral cavity. Methods. This multicenter retrospective analysis comprises 826 patients with squamous cell carcinoma of the or al cavity, all clinically NO. The primary tumor was treated by resecti on or brachytherapy. All patients underwent cervical dissection adapte d to the site of the tumor. Fourty seven N+ patients with capsular rup ture were excluded; 160 patients were N+ without capsular rupture (NCR-), and 619 were N-. Postoperative cervical irradiation was performe d in 67 of 160 N+ CR- patients and in 49 of 619 N- patients. Results. NR developed in 78 patients, associated with local recurrence in 33 ca ses and isolated in 45 cases. Twenty-six of the 45 cases of isolated N R occurred in the 619 N- patients (4%), and 19 occurred in the 160 NCR- patients (12%, p = .001). The 26 NR observed in the N- patients oc curred in nonirradiated patients. Among the 19 NR observed in the Nc C R- patients, the incidence of recurrence was not significantly differe nt between irradiated patients (6 NR of 67, 9%) and nonirradiated pati ents (13 NR of 93, 14%). NR rates also did not differ according to the number of lymph nodes invaded nor according to the level of the posit ive nodes; 14 of 45 isolated NR occurred in a nondissected suprahyoid region. Of 779 patients, 255 (33%) subsequently developed a metachrono us cancer: 153 upper respiratory and digestive tract tumors, 37 lung t umors, 33 esophageal tumors, and 32 other tumors. Isolated cervical fa ilure was responsible for 40 deaths. Conclusion. The low NR rate in NO N+ CR- patients means that postoperative irradiation can be confined to N+ CR+ patients and, as a precautionary measure, to patients with m ore than 3 N+ CR-. Keeping irradiation in reserve allows the treatment of metachronous cancers, which are particularly frequent in these pat ients, in whom the 5-year survival rate is 54% in N+ CR- and 69% in N- . (C) 1996 John Wiley & Sons, Inc.