The most effective methods of treatment of patients with head and neck cancer are surgery and radiotherapy. A combination of these in which radiotherapy preceeds surgery in a planned treatment protocol is attractive as it has the potential of combining the best features of each of these proven modalities.
The basis of rational preoperative radiation rests on a failure analysis for accepted therapy for all areas in which such treatment can be considered. When it can be shown that failure is due to lack of primary and regional control, and when survival by either irradiation or surgery alone is less than 50%, such a treatment regimen can be rationally applied. The closest cooperative effort between surgeon and radiotherapist and modification of each method of treatment–to avoid the cummulative bad effects and to provide the desirable benefits of each method–are necessary.
The necessary rational cooperative effort by those treating head and neck malignancies is largely lacking at the present time. The acceptance of the necessary principles for this method of therapy is developing but only slowly. Nevertheless, such combination of effective therapy still offers the greatest possibility for improvement in our presently accepted modalities for treatment of lesions of the hypopharynx, oral pharynx, advanced lesions of the oral cavity and the nasal sinuses.