COMBINED NECK DISSECTION AND POSTOPERATIVE RADIATION-THERAPY IN THE MANAGEMENT OF THE HIGH-RISK NECK - A MATCHED-PAIR ANALYSIS

Purpose: The purpose of this study was to determine the efficacy of po stoperative adjuvant radiation therapy with regard to reducing the rat e of recurrence in the neck, cancer-related death, and death from any cause in patients with squamous cell carcinoma of the head and neck re gion metastatic to neck nodes. Methods: This was a retrospective revie w of patients with pathologically confirmed nodal metastases who under went neck dissection and postoperative adjuvant radiation therapy for squamous cell carcinoma of the head and neck region. Time to recurrenc e in the dissected area of the neck, any recurrence in the neck, cance r-related death, and death from any cause were estimated with the Kapl an-Meier method. A matched-pair analysis was performed utilizing a coh ort of patients who underwent neck dissection without postoperative ra diation therapy. The patients hom the two cohorts were matched accordi ng to previously reported high-risk features for cancer recurrence and death. Cox hazards models for the matched pairs were used to evaluate the relative risk of subsequent recurrence in the dissected side of t he neck, any neck recurrence, cancer-related death, and overall surviv al. Materials: The medical records and pathologic slides of 95 consecu tive patients with pathologically confirmed nodal metastases from squa mous cell carcinoma of the head and neck region who underwent neck dis section and postoperative adjuvant radiation therapy between January 1 974 and December 1990 were reviewed. Previously published data from 28 4 patients with squamous cell carcinoma of the head and neck region tr eated with neck dissection alone between January 1970 and December 198 0 were used for a matched-pair analysis. Results: The relative risks f or recurrence in the dissected side of the neck, any neck recurrence ( dissected neck or delayed undissected neck metastasis), cancer-related death, and death from any cause for patients treated with operation a lone relative to those treated with operation and postoperative radiat ion were 5.82, 4.72, 2.21, and 1.67, respectively. Conclusion: This st udy provides evidence that postoperative adjuvant radiation therapy fo r the high-risk neck can reduce the rate of recurrence within a dissec ted neck, delayed metastasis within an undissected neck, cancer-relate d death, and death from any cause. (C) 1998 Elsevier Science Inc.