Intraoperative radiation therapy for advanced or recurrent head and neck cancer

Between 1982 and 1984, we treated 28 patients with advanced head and neck cancer with surgery, combined with intraoperative radiation. All patients had squamous cell carcinoma. One patient had two separate sites treated and a second patient was treated on two occasions, allowing 30 sites for analysis. The overall survival for all patients treated was 67% at 1 year. Local failure occurred in 13% of those with close surgical margins and 25% of those with microscopic residual disease. With gross residual disease 100% had local failure. Patients with gross residual disease had significantly higher local failure than microscopic residual disease (p less than 0.02) or close surgical margins (p less than 0.01). Carotid blowout was the major treatment complication. We believe intraoperative radiation is an effective treatment for advanced or recurrent head and neck cancer when all gross disease has been resected.