Recurrent Advanced (T3 or T4) Head and Neck Squamous Cell Carcinoma

Abstract

Background: Salvage surgery is often the only curative option for recurrent cancer. In patients whose initial tumor is stage T3 or T4, the primary therapy often makes salvage even more difficult. We therefore analyzed the outcome in patients who were originally treated for T3 or T4 squamous cell carcinoma of the oral cavity, larynx, oropharynx, or hypopharynx and who then had a recurrence and chose to undergo further therapy for cure.Patients and Methods: From 1980 to 2000, a total of 940 patients were treated for stage T3 or T4 cancer. Forty-eight patients underwent salvage therapy for recurrence: 24 for primary site recurrence, 20 for regional recurrence, and 4 for locoregional recurrence. Results:The mean time to recurrence was 14.0 months, and the mean survival time was 26.2 months. Among the 28 patients treated for primary site recurrence, the mean time to rerecurrence was 12.6 months, and the mean sur-vival time was 27.3 months. Only 5 of the 28 patients had prolonged survival. The stage of the recurrent disease did not influence outcome. Among the 20 patients treated for neck recurrence, the mean time to recurrence was 14.0 months, and the mean survival time was 25.0 months. Six of the 20 patients had prolonged survival, but none had a recurrence in a previously dissected and irradiated neck.Conclusions: These results show the limited potential for survival in patients who have a recurrence after treatment for advanced primary site head and neck cancer. Patients who have not undergone all modalities of therapy have the potential for salvage, but even then the chances are limited. Given the morbidity of salvage therapy, and the limited chance for cure, physicians must cautiously counsel patients who are contemplating treatment of recurrent cancer after therapy for advanced disease.

The effectiveness of salvage surgery after the failure of primary concomitant chemoradiation in head and neck cancer

“…The 2-and 5-year survival for 46 patients following salvage surgery was 31 percent and 15 percent, respectively; only 5 of 28 patients had long-term survival. 14 The largest meta-analysis to date of salvage surgery efficacy reviewed 32 studies involving HNSCC patients who had received any attempted organ-preserving treatment prior to undergoing surgery. 8 Overall median survival was 21.5 months, and the overall weighted average of 3-year survival rates was 37 percent.…”

When is reoperative surgery not indicated for recurrent head and neck squamous cell carcinoma?

“…In addition, salvage surgery in the oropharynx often results in significant morbidities, including dysarthria, dysphagia and aspiration, sometimes requiring total laryngectomy to restore swallowing and stop aspiration [8]. Hypopharyngeal recurrences have been reported to be technically resectable in only a third of recurrent cases [12,13]. These factors underscore the need to realistically consider the potentially severe consequences of surgical salvage in oro-and hypopharyngeal recurrences in light of the low rate of cure.…”

“…Not only does previous irradiation limit the possibilities of re-irradiation but recurrence after more aggressive primary treatment implies more resistant disease. In the study of Gleich et al [13], only one of the 12 patients initially treated with surgery plus radiotherapy were successfully salvaged. Moreover, patients who received adjuvant or neoadjuvant radiotherapy in addition to surgical resection for the previous cancer had a higher probability of surgical complications and morbidity [17].…”

Salvage surgery after failure of non surgical therapy for advanced head and neck cancer

“…Patients most likely to benefit from retreatment are those who have primary tumors stage I-II, recur greater than 6 months after theri initial treatment and develop recurrences that are amenable to salvage surgery. In his series, Gleich [21] confirmed the limited potential for survival in patients who have a recurrence after treatment for advanced (T3 or T4) primary site head and neck cancer. 48 patients underwent salvage therapy for recurrence.…”