To the Editor.—The comments by Drs Vikram and Blitzer are appreciated. This discussion of the relative value, place, and sequence of combined therapy using neck dissection and postoperative radiation to decrease the frequency of neck recurrence and increase cure rates in head and neck squamous cancer is probably the single most important and controversial issue in head and neck oncology today.
One issue raised by Vikram is my inquiry as to whether the use of radiation after dissection might in and of itself play a role in what seems to be an increase in frequency of distant metastasis.
Vikram's article cited a 25% incidence of distant metastasis node-positive patients, most of whom were treated with postoperative radiation. He states that when using historical controls and making retrospective comparisons "these data suggest that the addition of radiation to surgery does not appreciably alter the incidence of distant metastasis, it decreased the failure above
DESANTO LW. Irradiation After Neck Dissection-Reply. Arch Otolaryngol. 1985;111(12):828–829. doi:10.1001/archotol.1985.00800140072018
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