title: Preservation of function by radiotherapy of small primary carcinomas preceded by neck dissection for extensive nodal metastases of the head and neck.
abstract: BACKGROUND
  When patients are initially seen with a small primary tumor and regional metastases, the question arises whether the primary can be managed by definitive radiotherapy while treating the neck with surgery and postoperative radiation. The advantage of this is least disturbance of the primary site, while still achieving maximal control of the neck disease.
  
  
  METHODS
  A retrospective review was conducted over an 8-year period; of the 619 patients seen during this time, 15 were judged suitable for this approach. Small primaries were defined as T1 or T2 lesions or superficial spreading T3 tumors. Extensive neck disease was defined as at least 3 cm in size.
  
  
  RESULTS
  There were no regional recurrences and only 3 local recurrences, 2 of which were successfully salvaged. Four patients died of distant metastases. The arguments for and against this unusual approach are discussed.
  
  
  CONCLUSIONS
  It is concluded that, in patients conforming to our criteria, this is a sound oncologic approach.
authors.affiliation: Department of Otolaryngology, The Netherlands Cancer Institute, Amsterdam.
authors.forename: H P
authors.initials: HP
authors.lastname: Verschuur
authors.forename: R B
authors.initials: RB
authors.lastname: Keus
authors.forename: F J
authors.initials: FJ
authors.lastname: Hilgers
authors.forename: A J
authors.initials: AJ
authors.lastname: Balm
authors.forename: R T
authors.initials: RT
authors.lastname: Gregor
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate