Rl. Foote et al., TUMOR-ABLATIVE SURGERY, MICROVASCULAR FREE TISSUE TRANSFER RECONSTRUCTION, AND POSTOPERATIVE RADIATION-THERAPY FOR ADVANCED HEAD AND NECK-CANCER, Mayo Clinic proceedings, 69(2), 1994, pp. 122-130
Objective: The objectives of this study were to determine whether the
combination of complex tumor-ablative surgery and microvascular free t
issue transfer reconstruction delays the onset of postoperative radiat
ion therapy, whether free tissue transfers are lost after a course of
radiation therapy, and what patterns of tumor recurrence and survival
rates are present in patients who undergo this type of. multidisciplin
ary treatment. Design: A retrospective review was conducted in 37 pati
ents who underwent tumor-ablative surgery and reconstruction between N
ovember 1987 and August 1991. Material and Methods: Of the 30 men and
7 women mho underwent tumor-ablative surgery, microvascular free tissu
e transfer reconstruction, and postoperative radiation therapy, recurr
ent or T4 primary tumors mere treated in 84%. Sixty-two percent of the
patients had nodal metastatic disease. The median dose of postoperati
ve irradiation was 60 Gy (range, 32.4 to 76.8). Follow-up in all patie
nts mas until death (21 patients) or for a median of 17.5 months (rang
e, 4.1 to 43.2). Results: The median duration of overall survival and
the 2-year overall survival rate were 17 months and 46%, respectively.
For cause-specific survival, the median duration and 2-year rate were
17 months and 50%, respectively. Local recurrence developed in 8 pati
ents, neck recurrence in 10, and distant metastatic disease in 11. No
microvascular free tissue transfers failed. e Conclusion: Radiation th
erapy can begin in most patients within 8 weeks postoperatively, micro
vascular free tissue transfers seem to tolerate postoperative radiatio
n therapy well at the doses administered, and the rates of local and n
eck control are reasonable relative to the advanced stage of the cance
rs treated.