Salvage surgery for locally recurrent oropharyngeal cancer

Abstract

Surgical salvage for oropharyngeal SCC after failure of radiotherapy (+/- chemotherapy) is feasible. Patients who may benefit from surgery include those without regional recurrence and/or those in whom negative margins can be obtained. However, patients may be tracheotomy or gastrostomy tube dependent. The p16 status did not seem to have prognostic impact in the salvage setting; however, larger series are required to assess this relationship. © 2015 Wiley Periodicals, Inc. Head Neck 38: E658-E664, 2016.

Disease‐free survival after salvage therapy for recurrent oropharyngeal squamous cell carcinoma

“…Salvage modality was another important prognostic factor associated with OS. Consistent with recent reports, surgical salvage conferred a significant prognostic advantage as compared to nonsurgical salvage (aHR = 0.45; 95% CI = 0.21–0.98) . It is important to underscore the potential for selection biases, such as comorbidities, performance status, and/or resectability of recurrence, which may have influenced the type of salvage therapy and survival outcomes.…”

“…Conversely, positive margins may represent poor selection criteria for surgical therapy and/or an unfavorable tumor location. Multiple studies have shown that a positive surgical margin predicts a greater risk of recurrence after salvage, but only one previous study has investigated margin status in the setting of recurrent HPV‐oropharyngeal SCC …”

The Presence of HPV DNA in Neck Lymph Node Metastasis Correlates with Improved Overall Survival of Patients with Oropharyngeal Cancer Undergoing Surgical Treatment

“…Guo et al [22] reported that surgical salvage was associated with improved OS for 65 cases of recurrent locoregional OPSCC and 43 cases of distant metastatic OPSCC; this relationship existed independently of tumour HPV status. This result is consistent with a study reported by Patel et al [23] in which HPV status was not associated with either OS or relapse-free survival in 34 patients who underwent salvage surgery for locally recurrent or persistent OPSCC after chemoradiotherapy. In the current study, because the majority of the salvage therapies did not consist of surgery but rather of chemoradiotherapy, the HPVpositive patients who underwent surgery as a first-line therapy for OPSCC had a survival advantage.…”

Follow-up in Head and Neck Cancer: Do More Does It Mean Do Better? A Systematic Review and Our Proposal Based on Our Experience

“…However, patients treated with salvage surgery may be tracheotomy or gastrostomy tube dependent. p16 status did not appear to have prognostic impact in the salvage setting [6]. …”

“…The overall survival (OS) rate of patients treated with re-irradiation at 2-year range from 30% to 67% according to RT techniques (external beam 3-dimensional RT versus intensity modulated RT versus high-dose-rate brachytherapy) and disease extension (outcome in resectable disease suitable for re-irradiation ranges from 30% to 48% while outcome with re-irradiation in non-resectable disease ranges from 5% to 20% at 2 years) [6-10]. …”