Salvage surgery in head and neck cancer

Weert, Stijn van; Leemans, C. René

doi:10.1111/odi.13582

Cited by 29 publications

(27 citation statements)

References 58 publications

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“…Several retrospective and prospective studies evaluated the concept of salvage surgery for patients suffering from recurrent head and neck cancer, mostly advocating the use of free flaps for the reconstruction of large tissue defects [ 14 , 15 , 16 , 17 , 18 ]. Although the term “salvage surgery” mostly applies to tumor resections with curative intent in patients with recurrent tumors and a history of previous (radio-) therapies, and consequently lacking alternatives to the surgical approach, the focus of the present study lies on extensive resections of head and neck tumors irrespective of the sequence of prior therapy to exemplify the possibilities and limitations of tumor surgery of the head and neck in general.…”

Section: Discussionmentioning

confidence: 99%

Full-Thickness Tumor Resection of Oral Cancer Involving the Facial Skin—Microsurgical Reconstruction of Extensive Defects after Radical Treatment of Advanced Squamous Cell Carcinoma

Moratin

Mrosek

Horn

et al. 2021

Cancers

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Advanced tumors of the head and neck are challenging for the treatment specialist due to the need to synergize oncological and functional requirements. Free flap reconstruction has been established as the standard of care for defects following tumor resection. However, depending on the affected anatomic subsite, advanced tumors may impose specific difficulties regarding reconstruction, especially when full-thickness resection is required. This study aimed to evaluate reconstructive strategies and oncological outcomes in patients with full-thickness resection of the oral cavity. A total of 33 patients with extensive defects due to squamous cell carcinoma of the oral cavity were identified. Indications, reconstructive procedures, and clinical outcome were evaluated. Thirty-two patients (97%) presented locally advanced tumors (T3/T4). Complete tumor resection was achieved in 26 patients (78.8%). The anterolateral thigh flap was the most frequently used flap (47.1%), and the primary flap success rate was 84.8%. The cohort demonstrated a good local control rate and moderate overall and progression-free survival rates. Most patients regained full competence regarding oral alimentation and speech. Full-thickness tumor resections of the head and neck area may be necessary due to advanced tumors in critical anatomic areas. In many cases, radical surgical treatment leads to good oncological results. Free flap reconstruction has been shown to be a suitable option for extensive defects in aesthetically challenging regions.

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Section: Discussionmentioning

confidence: 99%

Full-Thickness Tumor Resection of Oral Cancer Involving the Facial Skin—Microsurgical Reconstruction of Extensive Defects after Radical Treatment of Advanced Squamous Cell Carcinoma

Moratin

Mrosek

Horn

et al. 2021

Cancers

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“…However, due to the proximity to the parapharyngeal space and internal carotid artery and more difficult accessibility compared to the oral cavity, this location of recurrence makes salvage surgery still difficult. While older published survival data were disillusioning [ 14 , 15 ], newer ones show more promising outcomes [ 16 ].…”

Section: Predictors Of Successmentioning

confidence: 99%

Opportunities and Limits in Salvage Surgery in Persistent or Recurrent Head and Neck Squamous Cell Carcinoma

Huber

2021

Cancers

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Except for HPV-induced cancers of the oropharynx, survival rates in patients with squamous cell carcinoma of the head and neck (HNSCC) have not changed substantially over the last decades. Salvage surgery plays an important role where primary treatment was unsuccessful since 50% of advanced-stage patients relapse after nonsurgical primary treatment. Depending on a variety of factors, a considerable number of patients in whom primary treatment was not successful can still be cured by salvage surgery. It is the goal of this review to elucidate these factors with the aim to counsel patients and their relatives realistically about the chances of being cured.

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“…Rigorous scientific studies are needed to test this concept because recurrences can be difficult to treat. Salvage treatment of recurrences is a challenge to oncologists and a burden for the patient (van Weert & Leemans, 2020).…”

Section: Figurementioning

confidence: 99%

“…Some authors suggest that when a margin <5 mm is obtained in surgical removal of early stage oral cancer (T1), adjuvant treatment may not be needed when there are no signs of aggressive growth patterns (invasive front, peri-neural growth, lymph-vascular invasion)(Jang et al, 2017). Rigorous scientific studies are needed to test this concept because recurrences can be difficult to treat.Salvage treatment of recurrences is a challenge to oncologists and a burden for the patient(van Weert & Leemans, 2020).…”

mentioning

confidence: 99%

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Cooperation as core value in an innovative era

Witjes

Vissink

2020

Oral Diseases

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Cooperation as core value in an innovative era Diagnosis, treatment, and rehabilitation of patients suffering from oral cancer are shared responsibilities of primary care givers like dentists, physicians and oral medicine specialists, and intramural secondary care specialties. Because of the complex nature of treatment and the necessity of long-term care in most patients, the treatment and follow-up of head and neck cancer patients are confined to centers with dedicated teams in most countries. Early referral of patients suspected for oral cancer is considered important because survival is related to tumor stage and primary care givers play a pivotal role in that respect (Grafton-Clarke et al., 2019). Where health care is organized with possibilities of a quick and easy referral, the risk of delayed referral is greatly reduced. dental rehabilitation after oncological surgery. Several practical issues remain to be resolved, however, such as the timing of placement of dental implants as well as the placement of dental implants in free flaps. Like for surgical planning, planning of an oral rehabilitation is supported by 3D technology. This technology supports precise placement of implants and design of prosthetic devices. Notwithstanding the long experience with dental implants, new ideas based on implant technology still emerge and become implemented in clinical practice. The application of zygoma implants after maxillectomy in combination with soft tissue flaps is an example of a creative idea finding its way into the clinic (Hackett et al., 2020). Treatment of cancer in the head and neck area is commonly accompanied by damage to the salivary glands (Barazzuol et al., 2020; Vissink et al., 2015). Damage to the salivary glands is unavoidable as the salivary glands are located superficially and the ionizing radiation has to pass salivary gland tissue to reach the tumor. While there is many approach to minimize this radiation damage to salivary gland tissue, there is yet no satisfactory therapy to treat radiation-induced salivary gland damage. A feasible option might be harvesting salivary gland tissue during, for example, a head and neck dissection procedure, isolate and proliferate stem cells from this tissue and return these stem cells to the salivary glands that are damaged by the postoperative radiotherapy. Such stem cell therapy is an attractive option for the long-term treatment of hyposalivation related xerostomia induced by irradiation, but is in need of further study in animals and preliminary studies in human before it can evolve into a clinically applicable method. Future studies should also focus on a better understanding of the radiosensitivity of parotid and submandibular salivary gland tissue (Serrano Martinez et al., 2020). All these developments show the benefits for patients of a good cooperation between primary and secondary caregivers. The good cooperation also demonstrates what can be achieved if efforts are focused and put into practice.

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Salvage surgery in head and neck cancer

Cited by 29 publications

References 58 publications

Full-Thickness Tumor Resection of Oral Cancer Involving the Facial Skin—Microsurgical Reconstruction of Extensive Defects after Radical Treatment of Advanced Squamous Cell Carcinoma

Full-Thickness Tumor Resection of Oral Cancer Involving the Facial Skin—Microsurgical Reconstruction of Extensive Defects after Radical Treatment of Advanced Squamous Cell Carcinoma

Opportunities and Limits in Salvage Surgery in Persistent or Recurrent Head and Neck Squamous Cell Carcinoma

Cooperation as core value in an innovative era

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