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Postoperative treatment intensification for improving outcome in the high‐risk patient: An evolutionary process

Until recently, advances in surgery and postoperative radiation therapy for head and neck cancer have not improved survival. Strategies for improving outcome initially included more radical resections and intensification of postoperative radiation therapy. In the late 1980s, the widespread introduction of free tissue transfer broadened reconstructive options and permitted even more aggressive surgical resection. Reliable reconstruction provided the ablative surgeon greater latitude to obtain wider margins aimed at improving local control and survival. Over time, it became apparent that gains in locoregional control could be offset by distant failure, the development of second primary tumors, and intercurrent disease related to common risk factors.