16514 Background: Squamous cell cancers of the head and neck are one of the most common malignancies in India. Most patients present in advanced stages of disease. Postoperative radiotherapy is generally an integral part of management in these patients. Methods: Patients of head and neck squamous cell cancers treated with surgery and postoperative radiotherapy at AIIMS between January 1999 to December 2004 were retrospectively analyzed. Results: A total of 386 patients were treated of which 281 were available for evaluation. There were 233 males and 48 females. Median age was 46 years (range 18–73). Site-wise distribution was: oral cavity- 202, larynx-55, hypopharynx-14, paranasal sinus-4, oropharynx-4, neck nodes with unknown primary-2. Post-surgical margins were adequate in 241, close in 5 (2%) and positive in 35 (12%). Pathological stage grouping was: Stage I- 11(4%), Stage II- 52 (18%), Stage III- 63(22%), Stage IV- 155 (55%). Neck node dissection was done in 245 patients and nodes were pathologically negative in 119 (42%). Extracapsular extension (ECE) was seen in 19(7%) patients. Bone/cartilage invasion was seen in 62(22%). Patients with high risk features (close/positive margins, ECE, 4/> positive nodes) were prescribed a dose of 64 Gy while the rest were planned to receive 60 Gy. 85% of patients completed the intended course of radiation. At a median follow up of 37 months, local recurrences were seen in 28 (10%), regional recurrence in 25 (9%) and distant metastasis in 10 (4%) patients. A second malignant neoplasm occurred in 6 patients (3-oropharynx, 2-oral cavity, 1-lung). Disease free survival (DFS) was 68%. ECE, post-surgical margin status and pathological lymph node status were significantly associated with DFS. Duration of postoperative radiotherapy and the surgery to radiotherapy interval did not significantly affect DFS. Conclusions: ECE, postsurgical margin status and pathological lymph node status significantly impact DFS in patients of surgically treated squamous cell cancers of head and neck. These patients require doses of adjuvant radiation >/=64 Gy. No significant financial relationships to disclose.
Prognostic Value of Lymph Node Status Is Greater Than Lymph Node Ratio and AJCC N Staging for Head and Neck Squamous Cell Carcinomas