Complications of combined therapy in head and neck carcinomas

The combined modalities of surgery and radiation therapy in the treatment of head and neck cancer have vasity improved survival rates of larger neoplasms with heretofore poor prognoses, when treated with either modality alone. One of the unfortunate problems with combined therapy is the increase in postoperative complications. During the past four years, in the Department of Otorhinolaryngology, University of California, Davis we have used both preoperative and postoperative radiotherapy in a random fashion in the combined approach to head and neck cancer in 45 patients. We have also operated on 37 patients whose conditions failed to respond to radiation. The complication rate of these three groups is compared. Each group was examined for possible contributing factors to these complications, such as age, hemoglobin levels, serum protein levels, albumin-globulin ratios, and preoperative weight loss. Our results show that surgery for radiation failures is met with a disastrously high complication rate, 45% of them of the major category. Postoperative radiotherapy results in a much lower complication rate than when radiation is used preoperatively and is our treatment of choice.