IL TRATTAMENTO RADIOTERAPICO PRECAUZIONALE DEI LINFONO- DI LATERO-CERVICALI NEI CARCINOMI CERVICO-CEFALICI

In patients affected with head and neck cancer, without clinically involved lymph nodes, some kind of prophylactic treatment of cervical lymphatics may be advisable. Surgery is the traditional choice and is usually regarded as the most effective one. It is mostly performed by a conservative neck dissection according to Suarez. The efficacy of prophylactic irradiation of cervical lymphatic chains has not yet been fully assessed. The aim of this study was to evaluate the incidence of lymphonodal relapses in a series of patients treated by radiotherapy. Because of the short follow-up the incidence of relapses was estimated by means of an actuarial computation. All relapses took place within 18 months of the end of treatment. In patients affected with laryngeal carcinoma who underwent radiotherapy, the cumulative probability of lymphatic relapse was 4.23% ± 0.16% at 18 months. The cumulative probability of exclusively lymphatic relapse was 2.95% ± 0.3% at 18 months. The results of prophylactic RT seem not to be different from those of the best surgical reports. Moreover, late damages are always scanty after low doses of irradiaton for bilateral prophylactic treatment of the neck (nearly 45 Gy). Our study shows that a controlled clinical trial could be used to confirm the efficacy of lymphatic irradiation in head and neck cancer with no lymph node metastases.