TUMOR-ABLATIVE SURGERY, MICROVASCULAR FREE TISSUE TRANSFER RECONSTRUCTION, AND POSTOPERATIVE RADIATION-THERAPY FOR ADVANCED HEAD AND NECK-CANCER

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.