IMPORTANCE OF THE TIME INTERVAL BETWEEN SURGERY AND POST-OPERATIVE RADIATION-THERAPY IN THE COMBINED MANAGEMENT OF HEAD AND NECK-CANCER

Twenty-two patients with advanced carcinomas of various head and neck sites were treated with surgical resection followed by elective postoperative radiation therapy. No patient had gross residual or recurrent disease at the time radiation therapy was started. The time interval from surgery to the start of radiation therapy varied from two and one half weeks to sixteen weeks; the median was seven weeks. Doses of radiation varied from 4500 rad to 5400 rad in five to five and one half weeks. One patient was lost to follow-up. Of the remaining twenty-one patients ten were alive with no evidence of disease (NED) at two to four years (48 %). We observed that 7 of 10 (70 %) of patients whose radiation therapy was started within seven weeks after surgery, were alive free of disease; however, only 3 of 11 (27 %) of those in whom there was a delay of seven weeks or more survived free of disease. Furthermore, in the former group there were virtually no local or regional recurrences, regardless of the stage of the disease, while in the latter group the incidence of local or regional recurrences was 64 %. These data suggest that delay in the start of postoperative radiation therapy, even in the absense of gross recurrent tumor, might adversely affect the results of combined surgical and radiotherapeutic management of head and neck cancers. © 1979.