Fixed, bilateral cervical nodes

A series of 1,726 previously untreated patients with squamous carcinoma of the Head and Neck is presented. 64 patients (3.7 per cent) had bilateral mobile nodes in the neck (N2). 128 (7.4 per cent) had unilateral fixed nodes (N3) and 24 (1.4 per cent) had bilateral nodes, one or more of which were fixed ('N4'). The N2 and N4 groups were similar with respect to the characteristics of the patient and his tumour such as primary site, etc., but the N3 group differed significantly: more patients were in poor general health and this group contained almost all the patients with no known primary tumour. The proportion of patients treated fell from 75 per cent for N2 to 47 per cent for N3 and 25 per cent for N4. The survival fell significantly with N stage: at one year the survivals were respectively 44 per cent, 30 per cent and 6 per cent. Very few patients in the N4 group survive to one year, and it is doubtful if this group should be treated at all.