Irradiation after neck dissection.

To the Editor .—DeSanto et al 1 have twice misquoted us. On page 369, they cite one of our articles 2 as suggesting that "A new and realistic concern is that the effects of radiation on lymphatics may actually facilitate distant metastases and decrease survivorship rather than improve it." In actual fact, rather than raising such concerns, our data are really reassuring in this regard; we found that the overall incidence of distant metastases in patients treated by the combination of surgery and postoperative radiation therapy was remarkably similar to what had been previously observed at our institution in patients treated by surgery alone. 3 On page 370, DeSanto et al again cite us, suggesting that "control of the disease (by postoperative radiation therapy) did not lead to increased survivorship." In actual fact, our data do show a rather striking decrease in deaths from head and neck cancer in patients treated by surgery