Precisely defining high-risk operable head and neck tumors based on RTOG 85-03 and 88-24: Targets for postoperative radiochemotherapy?

Background. Local-regional recurrence of disease remains the major obstacle to cure of advanced head and neck cancers. Methods. This investigation reviewed data derived from Radiation Therapy Oncology Group (RTOG) protocols 85-03 and 88-24 to identify characteristics of tumors that predicted local-regional recurrence of disease following surgery and postoperative radiotherapy (RT). Results. The presence of tumor in two or more lymph nodes, and/or extracapsular spread of nodal disease, and/or microscopic-size tumor involvement of the surgical margins of resection imparts a high risk of local-regional (L-R) relapse. Our data also support the hypothesis that, following surgery, the concurrent addition of chemotherapy (CT) to RT may increase the likelihood of L-R control of disease for patients who have these high-risk characteristics. Conclusion. A prospective trial of surgery followed by concurrent RT and CT is warranted for patients who have high-risk characteristics found at surgery.