Value of Preoperative X-Ray Therapy as an Adjunct to Radical Neck Dissection

Abstract

In 1960, the Head and Neck Service and the Department of Radiation Therapy of the Memorial Hospital Center, New York, N. Y., instituted a controlled clinical study to determine the value of preoperative irradiation in the prevention of recurrence after radical neck dissection. To avoid a significant delay in surgery as well as complications, a tissue dose of 2,000 rads to the subcutaneous tissues of the neck was chosen. This was given by 5 treatments, each of 400 R in air, on five successive treatment days immediately preceding the operation. All therapy was administered through one large lateral field which covered the whole neck and included the primary except when it was in the maxilla, the palate, or the nasopharynx. The Allis-Chambers betatron was employed, with an electron beam of 18 Mev maximum energy. Patients born on an odd day received preoperative radiation, while those born on an even day did not, thus constituting a control group. It was agreed at the outset of the study that the patients in the irradiated group as well as in the control group must fulfill the following conditions: 1. Ward patients of the Head and Neck Service 2. Primary in the region of the head and neck 3. Proved epidermoid carcinoma in primary 4. No prior surgical or radiological treatment at the site of neck dissection 5. No gross disease left behind during the radical neck dissection 6. No postoperative x-ray therapy 7. No interstitial implant at surgery 8. Patients dying before the end of the study period without recurrence in the dissected neck to be excluded in the evaluation of local recurrences. In a preliminary communication (1) in February 1964, we reported on an irradiated and a control group, each consisting of 61 consecutively treated patients for whom a one-year follow-up was available on Oct. 1, 1963. Local recurrences at the end of one year were observed in 13 per cent of those in the irradiated group and in 33 per cent in the control group. As pointed out in our previous preliminary publication, the irradiated and control groups were similar in age and sex distribution, in the number of primaries resected at the time of the radical neck dissection, and in the number of positive nodes found in the pathologic specimen. However, the irradiated and the control groups showed considerable variation in the number of different head and neck primaries. Since the various types of primaries differ markedly in their proclivity to metastasize to the neck, our findings could not be accepted as conclusive. In this report we are now able to present the three-year results in an irradiated and a control group exactly matched as to type and number of primaries as well as fulfilling all other criteria listed above. This was accomplished by taking the first 60 patients of the irradiated group and, from the control group, consecutive patients with corresponding primaries.