Preservation of function by radiotherapy of small primary carcinomas preceded by neck dissection for extensive nodal metastases of the head and neck.

BACKGROUND: When patients are initially seen with a small primary tumor and regional metastases, the question arises whether the primary can be managed by definitive radiotherapy while treating the neck with surgery and postoperative radiation. The advantage of this is least disturbance of the primary site, while still achieving maximal control of the neck disease.
METHOD: A retrospective review was conducted over an 8-year period; of the 619 patients seen during this time, 15 were judged suitable for this approach. Small primaries were defined as T1 or T2 lesions or superficial spreading T3 tumors. Extensive neck disease was defined as at least 3 cm in size.
RESULTS: There were no regional recurrences and only 3 local recurrences, 2 of which were successfully salvaged. Four patients died of distant metastases. The arguments for and against this unusual approach are discussed.
CONCLUSIONS: It is concluded that, in patients conforming to our criteria, this is a sound oncologic approach.