To the Editor.—In the June Archives, DeSanto et al1 reported that 155 patients with cancer of the head and neck region treated by radical neck dissection and postoperative irradiation had the same chance of local failure as 837 patients treated by surgery alone. The conclusion of the authors is that the irradiation was ineffective. In this letter, I shall attempt to demonstrate that this conclusion is not valid because the article suffers from the classic weakness of nonrandomized studies of irradiation, namely, failure to control for extent of disease. More specifically, I raise the following questions:
Was the choice of whether a patient should undergo irradiation based, at least in part, on the characteristics of his disease? The decision to irradiate usually is not capricious. There are several indications for irradiating after a radical neck dissection,2 such as multiple positive nodes, extracapsular extension, bulky disease, or
BLITZER PH. Irradiation After Neck Dissection. Arch Otolaryngol. 1985;111(12):827. doi:10.1001/archotol.1985.00800140071016
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