Tumor-Ablative Surgery, Microvascular Free Tissue Transfer Reconstruction, and Postoperative Radiation Therapy for Advanced Head and Neck Cancer

Abstract

The objectives of this study were to determine whether the combination of complex tumor-ablative surgery and microvascular free tissue transfer reconstruction delays the onset of postoperative radiation therapy, whether free tissue transfers are lost after a course of radiation therapy, and what patterns of tumor recurrence and survival rates are present in patients who undergo this type of multidisciplinary treatment. A retrospective review was conducted in 37 patients who underwent tumor-ablative surgery and reconstruction between November 1987 and August 1991. Of the 30 men and 7 women who underwent tumor-ablative surgery, microvascular free tissue transfer reconstruction, and postoperative radiation therapy, recurrent or T4 primary tumors were treated in 84%. Sixty-two percent of the patients had nodal metastatic disease. The median dose of postoperative irradiation was 60 Gy (range, 32.4 to 76.8). Follow-up in all patients was until death (21 patients) or for a median of 17.5 months (range, 4.1 to 43.2). The median duration of overall survival and the 2-year overall survival rate were 17 months and 46%, respectively. For cause-specific survival, the median duration and 2-year rate were 17 months and 50%, respectively. Local recurrence developed in 8 patients, neck recurrence in 10, and distant metastatic disease in 11. No microvascular free tissue transfers failed. Radiation therapy can begin in most patients within 8 weeks postoperatively, microvascular free tissue transfers seem to tolerate postoperative radiation therapy well at the doses administered, and the rates of local and neck control are reasonable relative to the advanced stage of the cancers treated.