Control by irradiation alone of nonfixed clinically positive lymph nodes from squamous cell carcinoma of the oral cavity, oropharynx, supraglottic larynx, and hypopharynx.

The records from 1948 through 1967 of 344 previously untreated patients with squamous cell carcinoma of the oral cavity, oropharynx, supraglottic larynx and hypopharynx who had clinically positive cervical lymph node metastases staged N1, N2A, or N2B, and whose initial neck treatment consisted of external radiation therapy alone were reviewed. After appropriate exclusions the study group consists of 183 patients. The dose to the lymph node(s) was calculated retrospectively. The control rates for N1 lymph nodes are 91.5 per cent (76/83) and for N2 lymph nodes 78.5 per cent (55/70) in the patients whose lymph node(s) were well included in the irradiated volume and received a known dose. A dose response analysis shows that doses in the range of 6,500 rads to a single lymph node, 3 cm. or less in diameter, produce 90 per cent control. When a nonfixed metastatic lymph node of 3 cm. or more in diameter of multiple lymph nodes are present or there is questionable coverage, external irradiation alone cannot be relied upon for control and a neck dissection should follow.