Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

Abstract

With the increasing use of concomitant chemoradiotherapy (CCRT) in the treatment of advanced head and neck carcinoma, surgery has lost ground as the first therapy and is reserved as a salvage treatment in cases of locoregional failure. The objective of our study was to review our experience in patients who had a local or regional recurrence after treatment with CCRT. Thirty-two patients underwent salvage surgery after CCRT: 24 were treated with a local or locoregional resection and 8 patients with a neck dissection only. In patients who had surgery involving the primary location of the tumor, some kind of reconstruction was required in 83% of cases. One or more postoperative complications occurred in nine patients. The median hospital stay was 18.5 days. There was a significant difference in hospital stay in relation to the appearance of surgical complications. Five-year adjusted survival after salvage surgery was 34.2% (CI 95% 13.2-55.2%). Adjusted survival was related to the status of the resection margins and appearance of neck nodes with extracapsular spread in the neck dissection. In conclusion, salvage surgery after CCRT involves extensive resections, requiring reconstruction techniques with regional or microanastomosed free flaps in most cases, achieving acceptable outcomes.

Update of Assessment of Survival in Head and Neck Cancer after Regional Recurrence

“…Recurrent disease is often understaged by clinical examination and imaging studies [15]. Experimental studies show that active disease may contribute to the quiescence of metastatic foci, and treatment of metastasis may promote the growth of subclinical disease in other sites, both related to angiogenic modulation [16–18].…”

Salvage surgery for oropharyngeal squamous cell carcinomas: A retrospective study from 2005 to 2013

“…In spite of the burden of such procedures, the overall and recurrence‐free survival rates are modest. The median duration of overall survival ranges from 19 to 21.5 months depending on the series, versus 3.5 to 3.8 months for patients under supportive care …”

Accuracy of [18Fluorine]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography-Computed Tomography Response Assessment Following (Chemo)radiotherapy for Locally Advanced Laryngeal/Hypopharyngeal Carcinoma

“…In the event of persistent primary disease following completion of treatment, salvage surgery has curative potential. Surgery to the primary site and/or neck is associated with the potential for significant morbidity 3,5,6…”