Adjuvant radiotherapy influences the survival of patients with squamous carcinoma of the head and neck who have poor prognoses

The treatment of carcinoma of the head and neck in recent years has improve d significantly, chiefly thanks to progress in surgery and radiotherapy Des pite these advances, the survival statistics reported in the literature sho w no appreciable evidence of radical improvement. The aims of this study we re to evaluate the impact on survival achieved with the combination of surg ical and postoperative radiotherapy in patients with advanced head and neck carcinomas and to identify the prognostic value of several host- and tumor -related factors that can influence the results of combined treatment. We r etrospectively reviewed the medical records of 394 patients with stage III and IV carcinoma of the head and neck, of whom 170 (43%) underwent surgery alone and 224 (57%) received combined surgery and postoperative radiotherap y. The 394 patients were stratified for a set of variables including the pa tient's condition, the characteristics of the tumor, and the modality of tr eatment, Univariate analysis revealed that coexistent medical diseases, the size and site of the primary lesion, the stage of the tumor, and certain p athologic features had a negative impact on survival. Multivariate analysis showed that the removal of lymph nodes and postoperative radiotherapy can have a positive influence and can improve the prognosis. We compared the su rvival rates of the patients treated with surgery alone with those of the p atients who underwent combined treatment, and comparable, even if there was a bias because the combined treatment group consisted of patients with neg ative prognostic factors. The meaning of these results, compared with data from the literature, has been discussed.