Positive surgical margins in neck dissection specimens in patients with head and neck squamous cell carcinoma and the effect of radiotherapy

Background. To evaluate the outcome after surgery and radiotherapy for extensive nodal disease in patients with primary head and neck cancer. Methods. Between 1973 and 1995, 77 from a total of 1398 patients had histopathologic evidence of positive margins in 85 neck dissection specimens for squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx. Postoperative radiotherapy with a curative dose was given to 50 necks. Ipsilateral neck recurrence was defined as the relevant event, and cumulative survival distributions were estimated by the Kaplan-Meier method. Differences between groups were analyzed with the log rank test. Results. Disease-free survival was 24.9% at 2 years, and disease-specific survival was 33.6% at 2 years. After restriction of the 50 patients who received postoperative curative radiotherapy, the time to neck recurrence was stratified according to irradiation dosage, with 62.5 Gy as the cutoff point. A statistically significant difference was found for patients treated with 62.5 Gy or more, with a regional control rate of 75.6% at 2 years (p < .036). Conclusions. The overall outcome after neck dissection with positive surgical margins is poor. Considerable improvement is achieved by postoperative radiotherapy treatment with dosages of 62.5 Gy or more. (C) 2000 John Wiley and Sons, Inc.