POSTOPERATIVE RADIATION OF FREE JEJUNAL AUTOGRAFTS IN PATIENTS WITH ADVANCED CANCER OF THE HEAD AND NECK

Background. Free jejunal autografts increasingly are being used to rep air the pharynx after resections of head and neck carcinomas. Doses of greater than 45 Gy are generally considered to be above the tolerance of the small bowel, whereas the dose range for effective postoperativ e radiotherapy of advanced head and neck cancers is between 57.6 Gy an d 63 Gy. Between July 1988, and December, 1992, 29 patients at the M. D. Anderson Cancer Center were treated with a combination of resection of the advanced head and neck cancer, reconstruction with free jejuna l autograft, and postoperative radiation. Planned reductions in postop erative doses due to the presence of the jejunum within the field were not made. This retrospective study analyzes the outcome of these pati ents with attention to survival, local-regional control, and complicat ions. Methods. Twenty-seven of the 29 study patients had squamous cell carcinoma of the larynx or pharynx; 24 of these patients had Stage II I or Stage IV disease. Two patients had recurrent papillary thyroid ca rcinoma. The median number of days from surgery to the start of radiat ion was 34. Radiation doses to the tumor bed ranged from 50 Gy to 72 G y. The median doses to the tumor bed and the jejunal autograft were bo th 63 Gy. Surviving patients were followed from 12 to 68 months (media n, 20 months) from the time of their surgery. Results. The actuarial 2 -year survival rate was 51%. Nine patients had local or regional recur rences above the clavicles. The 2-year local-regional control and free dom from relapse rates were 71 and 50%, respectively. The most severe complication during radiation was confluent mucositis in greater than 50% of the treated area, which developed in two patients. No patient d eveloped a late complication related to the jejunal autograft. Conclus ions. Postoperative radiation to free jejunal autografts used for phar yngeal reconstruction can be delivered safely. Doses in this setting o f 57.6 Gy to 63 Gy depending on the anticipated risk of recurrence bas ed on clinical, surgical, and pathologic findings are recommended. The presence of a free jejunal autograft did not require a reduction of t he desired doses used for patients with postoperatively irradiated hea d and neck cancer.