Management to prevent high-sited recurrence of pharyngo-laryngeal cancers.

The development of reconstructional techniques in cervico-facial surgery has led to the proposal of surgical solutions, in conjunction with radiotherapy, for the extensive epidermoid carcinomas of the oropharynx and hypopharynx that were formerly rejected by the surgeon. However these stage III or IV epidermoid carcinomas carry a heavy proportion of "high" recurrences, i.e. situated in the parapharyngeal, oropharyngeal and rhinopharyngeal regions. The reasons for this are: the lymphatic continuity between the oro- and hypopharynx and the parapharyngeal regions and the base of the skull; the limitation of neck dissections higher up at the tip of the mastoid and the lower parotid border; the limitation of postoperative irradiation directed upwards. Therefore for these lesions we propose an extended therapeutic programme comprising pre-operative chemotherapy based on cisplatinum, bleomycin and methotrexate, an adequately wide surgical resection followed by reconstruction and an irradiation extending upwards by two lateral fields to the oropharynx, the rhinopharynx and the parapharynx.