THE SECOG TRIALS IN ADVANCED HEAD AND NECK CANCER 3. THE ROLE OF SALVAGE SURGERY IN PATIENTS TREATED WITH RADICAL RADIOTHERAPY WITH AND WITHOUT CHEMOTHERAPY

This report concerns patients randomised in the SECOG trials of chemotherapy combined with radical radiotherapy as primary treatment of stage 3 and 4 squamous cell carcinoma of the head and neck. Treatment following failure at the primary site was not governed by the trial protocol. Of the 403 patients who received radiotherapy and chemotherapy 275 progressed or suffered recurrence locally and 138 subsequently underwent salvage surgery. From the operative mortality rate of 6.5% and a five year postoperative survival of 24%, it can be concluded that this is an acceptable method of salvage for these patients. The non-surgical treatments used in the SECOG protocols do not adversely affect the outcome from surgery. The 5 year post-operative 30% in patients node negative at time of initial presentation and 19% in those who were node positive. Of the 125 patients randomised initially with primary tumours in the larynx, only 53 (42%) underwent surgery although the overall 5 year survival for the whole group was 41%. Non-surgical treatment is therefore practicable and prevents loss of voice in a considerable proportion of patients (58%).