Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer.
OBJECTIVE
To determine whether external beam radiation therapy (XRT), administered either before or after surgery, increases the rate and/or severity of local postoperative complications in patients with head and neck cancer who undergo microvascular free flap reconstruction.


METHODS
Retrospective cohort study.


METHODS
University of Washington Medical Center, Seattle, a tertiary care hospital.


METHODS
A total of 100 consecutive patients underwent fibular free flap reconstruction of the mandible. The study cohort was divided according to radiation treatment status: (1) no XRT (28 patients), (2) preoperative XRT (37 patients), and (3) postoperative XRT (35 patients). The median follow-up after surgery was 11 months (range, 1-89 months).


METHODS
Rate and severity of local postoperative complications.


RESULTS
Fifty-four patients (54%) had at least 1 postoperative complication. There were no differences among the 3 XRT subgroups in the overall proportion of patients with complications of any severity (15 [54%] of 28 patients in the no XRT group, 24 [65%] of 37 patients in the preoperative XRT group, and 16 [46%] of 35 patients in the postoperative XRT group; P = .26, chi(2) analysis). There were also no differences seen when mild and severe complication rates were specifically examined (P = .58 and P = .10, respectively). No case of complete flap loss was observed. We noted no significant correlations between the rate of postoperative complications and the following covariates: total radiation dose, size of radiation field, disease stage, exposure to chemotherapy, presence of serious medical comorbidities, patient age, or history of tobacco use.


CONCLUSIONS
Our experience suggests that XRT can be safely administered before or after surgery to patients undergoing head and neck free flap reconstruction at an experienced surgical referral center. Postoperative complication rates were not significantly affected by administration, timing, dose, or extent of XRT.
Choi
Seungtaek
S
Department of Radiation Oncology, University of Washington, Seattle, USA.
Schwartz
David L
DL
Farwell
D Greg
DG
Austin-Seymour
Mary
M
Futran
Neal
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps