Squamous cell carcinoma with positive margins. Surgery and postoperative irradiation

The charts of patients treated surgically for squamous cell carcinoma of the head and neck were reviewed retrospectively to correlate the pathologic report of the adequacy of margins with subsequent treatment and eventual outcome. Three hundred forty-nine patients were studied. Thirty-one patients (8.8%) had positive margins. Positive margins were most commonly encountered in patients with tonsillar and hypopharyngeal lesions. Twenty-nine (94%) of the patients had stage III or IV disease. Two patients (6.4%) remain free of disease 36 months or longer following surgery. Radiation therapy was administered postoperatively to 25 patients. Sixty percent of these patients failed to achieve local-regional control, and 84% are dead of disease. When free margins of resection cannot be obtained due to anatomic limitation, postoperative radiation therapy has been unsatisfactory in our hands. Alternative treatment, such as radiation implants or chemotherapy, would appear to offer the only hope of improving the chances for long-term survival.