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Background: The efficacy of postoperative irradiation of the neck after lymph node dissection in terms of prevention of cervical node recurrence (NR) has not been demonstrated in patients with NO squamous cell carcinoma of the oral cavity., Methods: This multicenter retrospective analysis comprises 826 patients with squamous cell carcinoma of the oral cavity, all clinically NO. The primary tumor was treated by resection or brachytherapy. All patients underwent cervical dissection adapted to the site of the tumor. Fourty seven N+ patients with capsular rupture were excluded; 160 patients were N+ without capsular rupture (N+ CR-), and 619 were N-. Postoperative cervical irradiation was performed in 67 of 160 N+ CR- patients and in 49 of 619 N- patients., Results: NR developed in 78 patients, associated with local recurrence in 33 cases and isolated in 45 cases. Twenty-six of the 45 cases of isolated NR occurred in the 619 N- patients (4%), and 19 occurred in the 160 N+ CR- patients (12%, p = .001). The 26 NR observed in the N- patients occurred in nonirradiated patients. Among the 19 NR observed in the N+ CR- patients, the incidence of recurrence was not significantly different between irradiated patients (6 NR of 67.9%) and nonirradiated patients (13 NR of 93, 14%). NR rates also did not differ according to the number of lymph nodes invaded nor according to the level of the positive nodes; 14 of 45 isolated NR occurred in a nondissected suprahyoid region. Of 779 patients, 255 (33%) subsequently developed a metachronous cancer; 153 upper respiratory and digestive tract tumors, 37 lung tumors, 33 esophageal tumors, and 32 other tumors. Isolated cervical failure was responsible for 40 deaths., Conclusion: The low NR rate in NO N+ CR- patients means that postoperative irradiation can be confined to N+ CR+ patients and, as a precautionary measure, to patients with more than 3 N+ CR-. Keeping irradiation in reserve allows the treatment of metachronous cancers, which are particularly frequent in these patients, in whom the 5-year survival rate is 54% in N+ CR- and 69% in N-.

Two new drugs have been proved to be effective for isolated or recurrent stomatological tumors : detorubicine (limited because of cardiotoxicity), and CDDP (limited because of renal and neurological toxicity). Drugs used mainly as adjuvant treatment concurrently with BCG, as immunotherapy, are bestatine (without clinical or biological toxicity) and levamisole (rare cases of agranulocytosis). Randomized trials of chemo- and immunotherapy now underway are the only means of assessing long-term efficacy of adjuvant treatments.

Since January 1974, 95 patients with anterior tongue and floor of the mouth cancers were included in a randomized trial. After stratification according to staging and initial treatment, one-third of the patients received chemotherapy for 2 years (methotrexate 400 mg followed by citrovorum factor 100 mg + bleomycin 60 mg/week, during the first 15 weeks), one-third of the patients received immunotherapy with weekly C. parvum injections during 2 years, while the remaining third did not receive any treatment. If adjuvant treatment seems to delay recurrence it did not significantly decrease the recurrence rate. Survival is also not signigicantly modified by adjuvant treatment and was better for patients with small tumors. Patients who previously received radiotherapy did not benefit from adjuvant therapy.

The relatively poor results of therapy for epidermoid oropharyngeal carcinoma stages T3 and T4 suggested the need for new treatment regimens. A study involving 24 patients included bifractionated radiation on a daily basis, as used by J. C. Horiot and A. Nabib and then by the E.O.R.T.C. group. The more encouraging results reported by A. Nabib were not obtained. The 5-year survival rate will possibly be no better than after conventional external radiation. Post-radiotherapy complications were observed.

Vindesine, a vinblastine derivative, was evaluated in 36 patients with malignant tumours of the buccal cavity previously untreated. Vindesine was used (1) pre-operatively, in short, weekly intravenous courses for 1 to 3 weeks and (2) prior to radiotherapy of inoperable tumours, in prolonged treatments, either by bolus i.v. injections with vein washing weekly or, in case of failure, by continuous i.v. infusion over 5 days. In the first group major responses were obtained in 22.2% of the cases. In the second group only 1 of 18 patients responded to weekly injections, whereas 3 out of 10 patients responded to continuous infusion (including one complete remission), showing that this mode of administration was more effective than bolus injections. Toxic reactions to the drug are discussed. Venous damage was the predominant complication of continuous infusion.