Interruption of combined therapy: a factor in decreased survival

Occasionally, during the course of combined (radiation plus surgery) treatment of head and neck malignancies, the patient experiences a profound response to radiotherapy alone and elects to decline the second phase of treatment, namely, surgery. After a variable interval, radiotherapy is reinstituted to a "curative" level. A series of 14 laryngeal and oropharyngeal carcinomas, treated in this disjointed fashion, has been examined with respect to long-term survival. The prognosis is extremely unfavorable, thus supporting a basic philosophy of continuing with the prescribed surgical treatment despite a dramatic response to noncancericidal doses of radiotherapy. The site and stage of tumor, radiation dosage, interval to completion of therapy, and incidence of local and distant metastases are examined. It appears that every effort should be made to provide continuity in the combined therapeutic protocol if the advantages of this mode of therapy are to be effective.