Positive surgical margins in neck dissection specimens in patients with head and neck squamous cell carcinoma and the effect of radiotherapy.

BACKGROUND: To evaluate the outcome after surgery and radiotherapy for extensive nodal disease in patients with primary head and neck cancer.

METHODS: Between 1973 and 1995, 77 from a total of 1398 patients had histopathologic evidence of positive margins in 85 neck dissection specimens for squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx. Postoperative radiotherapy with a curative dose was given to 50 necks. Ipsilateral neck recurrence was defined as the relevant event, and cumulative survival distributions were estimated by the Kaplan-Meier method. Differences between groups were analyzed with the log rank test.

RESULTS: Disease-free survival was 24.9% at 2 years, and disease-specific survival was 33.6% at 2 years. After restriction of the 50 patients who received postoperative curative radiotherapy, the time to neck recurrence was stratified according to irradiation dosage, with 62.5 Gy as the cutoff point. A statistically significant difference was found for patients treated with 62.5 Gy or more, with a regional control rate of 75.6% at 2 years (p <.036).

CONCLUSIONS: The overall outcome after neck dissection with positive surgical margins is poor. Considerable improvement is achieved by postoperative radiotherapy treatment with dosages of 62.5 Gy or more.