Postoperative radiotherapy for insecure or positive surgical margins in head and neck cancer

Abstract

Purpose: Our goal was to determine dose adequacy in postoperative irradiation for insecure or positive resection margins in patients with head and neck cancer. Methods: A retrospective medical chart review was performed in 36 consecutive patients with “close” or “positive” surgical margins who were treated with radiation after definitive surgery for cancer of the upper aerodigestive tract during a 20-year period. Results: The 5-year estimated overall and disease-free survival rates were 25%. The overall locoregional failure rate was 15%. The failure rate in the primary tumor bed and upper neck was 25% with an administered total dose of less than 60 Gy and 8% with 60 Gy or more; the relapse rate in the lower neck was 3%. Of several factors examined as predictors for locoregional recurrence, none proved to be of significance. Conclusion: The observations from this study warrant data from prospective randomized trials before a definitive recommendation of postoperative radiotherapy dose escalation in cases of insecure or positive surgical margins is made. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:425-429, 2003