RECURRENCE AT THE PRIMARY SITE IN HEAD AND NECK-CANCER AND THE SIGNIFICANCE OF NECK LYMPH-NODE METASTASES AS A PROGNOSTIC FACTOR

Background. Biologic aggressiveness of head and neck carcinoma is refl ected in its capability to metastasize to regional lymph nodes and its propensity to recur after treatment. Methods. The authors report on 2 44 patients treated at the Department of Otolaryngology-Head and Neck Surgery of the Free University Hospital, Amsterdam, The Netherlands, w ith excision of primary tumor with incontinuity neck dissection with o r without postoperative radiation therapy between January 1973 and Jul y 1986. All patients had surgical margins free of tumor. Results. The overall recurrence rate was 12.3%. Stages T3-4 and the presence of mor e than three positive nodes on histopathologic examination were associ ated with a 16.2% and 26.2% incidence in recurrence at the primary sit e, respectively. No prognostic influence arose from primary tumor loca lization, three or fewer positive nodes, extranodal spread, and postop erative radiation therapy. Conclusions. Patients with T3-4 disease and those with more than three positive lymph nodes may benefit from nove l adjuvant treatment modalities.