This study analyzed the efficacy of transoral laser microsurgery and postoperative (chemo) radiotherapy (CRT) for head and neck squamous cell carcinoma. Between 1987 and 2007, 318 patients with pN2 neck disease were included. Seventy-three patients received laser resection and neck dissection alone, 154 postoperative radiotherapy, and 91 postoperative (C)RT. Mean follow-up was 58.2 ± 51.2 months, and locoregional control was significantly better after postoperative (C)RT (surgery alone: 42 %, radiotherapy: 57 %, CRT: 59 %; p < 0.01). Postoperative (C)RT did not have a significant impact on disease-specific survival (DSS) (surgery alone: 55 %, radiotherapy alone: 60 %, CRT: 64 %; p = 0.36). Fifty-seven patients (17.92 %) developed distant metastases, and 39 patients (12.26 %) presented with secondary malignancies, with no significant differences found between the treatment groups. Postoperative (C)RT significantly improved locoregional control, but had no significant effect on DSS because of high rates of secondary malignancies and distant metastases. Reduced radicality in combination with an effective screening might improve prognosis and quality of life of these patients.
Keywords: (Chemo)radiotherapy; HNSCC; Selective neck dissection; Transoral laser microsurgery; pN2.