When Is Postoperative Radiation Recommended

It is clear that postoperative radiation is not necessary when the histopathologic examination of a selective neck dissection shows no metastatic tumor in the lymph nodes. It also seems prudent to recommend postoperative radiation when extracapsular spread of the tumor is demonstrated in an elective neck dissection. It remains unclear whether radiation should be added to a selective neck dissection if there are one, two, or three histopathologically positive nodes.

TABLE 2-6

Supraglottic Carcinomas: Pattern of Recurrence in 142 Patients with Negative Level II Nodes (FS)a

TABLE 2-6

Supraglottic Carcinomas: Pattern of Recurrence in 142 Patients with Negative Level II Nodes (FS)a

Node Group

II

III

IV

V

Total

Ipsilateral

3(30%)

6(60%)

1(10%)

0(0)

10 (100%)

Contralateral

1(20%)

2(40%)

2(40%)

0(0)

5 (100%)

SOURCE: Modified from Gui-yi T. Upper neck (level II) dissection for N0 neck supraglottic carcinoma. Laryngoscope 1999;109:467-470.51 a Frozen section.

SOURCE: Modified from Gui-yi T. Upper neck (level II) dissection for N0 neck supraglottic carcinoma. Laryngoscope 1999;109:467-470.51 a Frozen section.

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Medina—CHAPTER 2

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The presence of regional lymph node metastasis at initial presentation is the single most important factor influencing the outcome of patients with upper aerodigestive tract squamous cell carcinomas.1-4 Accordingly, an aggressive approach to the management of patients presenting with obvious lymphatic metastasis is advocated. However, the management of clinically occult dissemination of squamous cell carcinoma to regional lymph nodes is a topic of considerable debate.5-11 The controversy focuses mainly on four issues: the need for elective treatment, selection of patients requiring intervention, the type of intervention to be used, and the benefit of such intervention to the patient.

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