title: Patterns of spread in recurrent head and neck squamous cell carcinoma.
abstract: OBJECTIVE
  To examine the pattern of spread regarding recurrent disease in primary head and neck squamous cell carcinoma.
  
  
  METHODS
  A retrospective study reviewed 128 patients who underwent primary tumor resection and postoperative radiation and/or chemoradiation for squamous cell carcinoma at Loyola University Medical Center from July 1993 to August 1998. Patterns of spread of recurrent disease were grouped according to site of recurrence and compared with the histopathology.
  
  
  RESULTS
  Of 128 patients, 40 (32%) had recurrent disease, 22 (17%) died without disease, and 66 (51%) are disease free. Although the recurrences in patients who were N0 were primarily local-regional (8/11), the majority of recurrences in patients that were N+ with extracapsular nodal spread involved distant sites (18/24); 17/18 involved metastasis to the lung.
  
  
  CONCLUSIONS
  This study gives the first report at our institution of patterns of spread in recurrent head and neck squamous cell cancer and compares these patterns within subgroups of patients based on the extent of neck disease at the time of primary surgical resection.
  
  
  CONCLUSIONS
  Not only was there a higher rate of recurrent disease in patients with extracapsular nodal spread, there was a much higher involvement of distant metastatic sites as opposed to local-regional recurrence more often seen with the N0 neck. The most common site of distant metastasis was the lung.
authors.affiliation: Department of Otolaryngology, Loyola University Medical Center, 2160 South First Ave., Maywood, IL 60153, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Vaidya
authors.forename: G J
authors.initials: GJ
authors.lastname: Petruzzelli
authors.forename: J
authors.initials: J
authors.lastname: Clark
authors.forename: B
authors.initials: B
authors.lastname: Emami
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D012189:Retrospective Studies