Two hundred forty-eight patients with primary epidermoid carcinoma of the oral cavity, oropharynx, and hypopharynx, stages II, III, and IV were entered into a prospective randomized clinical trial of preoperative irradiation therapy (700 rads X 2) and surgery versus surgery alone. At 5 years both groups had a similar survival when analyzed according to stage of disease, primary site, or lymph node status. However, the group of patients receiving preoperative irradiation showed a lower incidence of local recurrence (22% versus 36%) preoperative irradiation showed a lower incidence of local recurrence (22% versus 36%) (P = 0.02). From this study we conclude that preoperative irradiation in this dose schedule has little influence on the ultimate outcome after surgical treatment of head and neck cancer.

Extended resection of the trachea with construction of a mediastinal tracheostomy was performed upon 21 patients with primary or recurrent carcinoma involving the cervical part of the trachea. In 12 patients, major complications developed, and eight died of these complications. Necrosis of skin flaps and tracheal wall, leading to sepsis of the mediastinum and rupture of major vessels, were the two most common complications and causes of death. Three patients remained free of disease for 143, 77 and 48 months. A review of this experience suggests that this procedure should be limited to patients witha tumor localized to the cervical portion of the trachea and that well vascularized skin flaps--myocutaneous flaps--should be used to resurface the mediastinum and base of the neck as a means of preventing most of the complications reported in this investigation.

We have concluded from these observations in this pilot study that preoperative radiation therapy does not play a particularly helpful role in the management of patients who have the clinical finding of borderline operable carcinoma of the breast and it does not improve the survival rate. Patients within this category of locally advanced disease must be considered to have systemic metastatic disease at the time of diagnosis, as has previously been stressed by many. For this reason, any therapy directed to the regional area for local control must be combined with some form of systemic therapy if there is to be any hope for an increase in survival time.

One hundred and nine patients with unilateral breast carcinoma and no palpable abnormality of the contralateral breast were evaluated by opposite breast biopsy. Our patient population yielded four noninfiltrating carcinomas, and one infiltrating carcinoma for an incidence of 4.5%. The one infiltrating cancer was suspected on a preoperative mammogram. We have discontinued the routine use of the opposite breast biopsy as a diagnostic tool in patients with unilateral breast cancer, in patients with no palpable abnormality and a normal mammogram.

A prospective clinical trial of preoperative irradiation for Stage II, III, and IV squamous carcinoma of the head and neck was initiated at the Medical College of Virginia in January, 1969. In patients receiving preoperative therapy, treatment was calculated to give a midline total dose of 1,400 rads in two equal fractions delivered 24 and 48 hours prior to the surgical procedure for oral cavity, oropharyngeal, or pharyngeal cancer. The surgical procedure in all instances consisted of wide resection of the primary lesion in continuity with unilateral or bilateral neck dissection. By December 31, 1972 there were 143 patients entered into this study with followup periods ranging from 6 to 54 months. The morbidity, mortality, and survival characteristics of the preoperative irradiation and “surgery only” groups are essentially the same. No significant difference in local recurrence rate has been observed between the two groups. Although the different anatomical sites cannot be individually examined at this time, it is considered that no major change in clinical course will result from this type and dosage of preoperative irradiation to Stages II, III, and IV squamous carcinoma of the oral cavity, oropharynx, and pharynx.