Salvage Surgery for Patients With Recurrent Squamous Cell Carcinoma of the Upper Aerodigestive Tract: When Do the Ends Justify the Means?

Abstract

Objectives/Hypotheses: Salvage surgery is widely viewed as a "double-edged sword." It is the best option for many patients with recurrent cancer of the upper aerodigestive tract, especially when original therapy included irradiation, yet it may provide only modest benefit at high personal cost to the patient. The stakes are high because alternatives are of limited value. The primary objective of this study was to fully assess the value of salvage surgical procedures in the treatment oflocal and regional recurrence. The following hypotheses were developed to focus the study design and data analysis. 1) The efficacy of salvage surgery correlates recurrent stage, recurrent site, and time to presalvage recurrence.2) The economic and noneconomic costs of salvage surgery increase with higher recurrent stage. 3) Information relating the value of salvage surgery to recurrent stage and recurrent site will be useful to these patients and the physicians who treat them. Study De-sign: Two complimentary methods of investigation were used: a meta-analysis of the published literature and a prospective observational study of patients undergoing salvage surgery for recurrent cancer of the upper aerodigestive tract. Methods: The metaanalysis combined 32 published reports to obtain an estimate of average treatment effect for salvage surgery with regard to survival, disease-free survival, surgical complications, and operative mortality. The prospective observational study included detailed data in 109 patients who underwent salvage surgery. In addition to parameters studied in the metaanalysis, we obtained baseline and interval quality of life d ata (Functional Living Index for Cancer [FLIC] Presented as a Candida te's Th esis to the America n La ryngologica l, Rhinologica l a nd Otological Society, Inc.From , length of hospital stay, and hospital and physician charges, and related this data primarily to recurrent stage, recurrent site, and time to presalvage recurrence. Results: The weighted average of 5-year survival in the meta-analysis was 39% in 1,080 patients from 28 different institutions. In the prospective study, median disease-free survival was 17.9 months in 109 patients, and this correlated strongly with recurrent stage, weakly with recurrent site, and not at all with time to presalvage recurrence. Noneconomic costs for patients and economic costs correlated with recurrent stage, but not with site. Baseline FLIC and PSS head and neck scores correlated with recurrent stage, but not with site. After salvage surgery the percentage of patients reaching or exceeding baseline was 51 % for FLIC scores, and this differed significantly with recurrent stage. Postoperative interval "success" in PSS head and neck subscale scores for diet and eating in public also correlated with recurrent stage. Conclusions: Overall, the expected efficacy for salvage surgery in patients with recurrent head and neck cancer was surprisingly good, but success was limited and costs were great in stage Ill and, especially, in stage IV recurrences. A ...

Salvage surgery for head and neck squamous cell carcinoma

“…Despite advances in various treatment modalities, the overall prognosis of HNSCC patients has not improved significantly within the last several decades. About 50 % of patients survive their disease [3]. Advanced tumors have a recurrence rate of around 20-30 % at the primary tumor site and 10-15 % in the neck [3].…”

“…About 50 % of patients survive their disease [3]. Advanced tumors have a recurrence rate of around 20-30 % at the primary tumor site and 10-15 % in the neck [3].…”

Avaliação da sobrevida livre de doença de pacientes com recidiva loco-regional de carcinoma epidermóide de cavidade bucal e orofaringe submetidos a tratamento de resgate

“…Deve ser considerada mesmo naqueles casos em que o paciente não foi submetido às terapêuticas disponíveis no primeiro tratamento 11 . Segundo Cooney et al, 12 observaram bons resultados do resgate cirúrgico em somente 5% em cinco anos, com sobrevida média livre de doença de seis meses.…”

When is re-irradiation in head and neck squamous cell carcinoma not indicated?

“…Surgical removal of gross tumor mass before rRT circumvents this problem [9]. Finally, a meta-analysis of 32 surgical studies with 1,080 patients demonstrated a survival rate of 39 % at 5 years in patients treated by salvage surgery, compared with a 20-30 % overall survival rate at 2 years after rRT alone [3,10].…”