The purpose of this review is to document patterns of failure with the existing modalities of therapy in carcinomas of the upper aerodigestive tract. Most attention is given to regional failure, which is separately divided into primary site and metastatic cervical adenopathy. Survival, stage of the lesion, conversion of the clinically negative neck, and salvage of treatment failure is discussed.
Either with surgery, radiations or combination, the commonest regional failure still remains in the primary site.
Of additional importance is the unexpectedly poor salvage rate of previous treatment failures (16%).
Histologically involved lymph nodes appears to portend a poor prognosis with a high failure rate seen not only in the neck but also in the primary site with or without distant metastases. Nodal involvement indicates mostly the aggressive biological nature of the primary lesion. The most common failing by authors, whose reports had to be excluded from this review, was a preoccupation with survival statistics and a general inattention paid to documenting the specific failure site.