The long-term outcome after radical radiotherapy for advanced head and neck cancer.

Abstract

The patterns of local failure, salvage treatment, metastasis, second primary tumour and intercurrent disease are observed in 99 patients with advanced head and neck tumours, who were entered into a pilot study of CHART. The patients were treated between January 1985 and March 1990 and have a median follow-up of 59 months. All patients presented with squamous cell carcinoma of one of the major sites in the head and neck region, with 85% having T3-4 and/or N3 stage disease. Complete regression of locoregional disease was achieved in 89% of patients, but this fell to 49% at 5 years, 95% of those relapsing did so in the first 24 months. Using univariant analysis, N-stage influenced local tumour control, with N0 disease having a 5-year local tumour control rate of 62% compared with 33% for N+ disease. Local tumour control was not influenced by T-stage due to the disproportionate number of patients with T1-2 tumours who had nodal disease. Three of the 11 patients with residual disease underwent salvage therapy with surgery or further radiation; but failed to obtain local tumour control. Of the 39 patients judged to have recurrent disease two had no histological evidence of tumour when surgery was performed. Of the 21 who had salvage surgery 13 maintained local tumour control to last follow-up or death. Distant metastases occurred in 11 patients, all of whom also showed local failure. Thirteen of the 99 patients developed second primary tumours; these occurred most frequently after treatment for oral cavity tumours.(ABSTRACT TRUNCATED AT 250 WORDS)