Are postoperative complications more frequent and more serious after irradiation for laryngeal and hypopharyngeal cancer?

In order to improve local cure rates and survival in patients with head and neck cancer, combinations of radiotherapy and surgery are used. Most reports on such treatment results indicate an improvement with combined therapy. However, it is not clear whether it is best to irradiate before or after surgery. There is disagreement in the literature, whether postoperative complications are more frequent when the irradiation is given prior to surgery. The incidence of postoperative complications was studied in 213 patients who had a laryngectomy for laryngeal or hypopharyngeal cancer. The incidence of major complications was 8.5% after a preoperative dose of 40 or 50 Gy. After rescue surgery for radiation failure this percentage was 32%. In our experience, the incidence of postoperative complications after doses up to 50 Gy/5 weeks is comparable to what can be expected after surgery alone. When higher doses are given, these complications are more frequent. In designing treatment plans, such considerations should be kept in mind.