The role of salvage surgery in patients with recurrent squamous cell carcinoma of the oropharynx

Abstract

BACKGROUND: The objective of this study was to comprehensively review overall survival, functional outcomes, and prognostic factors in patients who underwent salvage surgery for locally recurrent squamous cell carcinoma of the oropharynx (SCCOP) after initial radiotherapy. METHODS: The authors retrospectively reviewed 1681 consecutive patients who completed definitive therapy for primary SCCOP and identified 168 patients with locally recurrent SCCOP who underwent salvage surgery (41 patients), reirradiation or brachytherapy (18 patients), palliative chemotherapy (70 patients), or supportive care (39 patients). RESULTS: Twenty‐six of 39 patients (67%) developed a second recurrence after salvage surgery. The 3‐year overall survival rate for patients who underwent salvage surgery or received reirradiation, palliative chemotherapy, or supportive care were 48.7%, 31.6%, 3.7%, and 5.1%, respectively. For patients who underwent salvage surgery, older age (P = .03), the absence of a disease‐free interval (P < .01), and advanced recurrent tumor stage (P = .07) were associated with lower overall survival. Patients with recurrent neck disease (P = .01) and positive surgical margins (P = .04) had higher rates of recurrence after salvage surgery. Postoperative complications occurred in 19 patients (46%), and there were no perioperative deaths. Functionally, 71% of patients demonstrated ≥80% speech intelligibility, 68% were able to tolerate some oral intake, and 87% who required a tracheotomy subsequently were decannulated. CONCLUSIONS: Age, disease‐free interval, recurrent tumor stage, recurrent neck disease, and surgical margin status influenced overall survival or recurrence rate after salvage surgery for recurrent SCCOP. Although most patients had good functional outcomes, only a select group of patients with recurrent SCCOP achieved long‐term survival after salvage surgery. Cancer 2009. © 2009 American Cancer Society.

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

“…This may be difficult to achieve in previously irradiated patients as the extent of disease may be difficult to evaluate even with ''state of the art'' imaging studies. Although recent advances in reconstructive procedures have increased the feasibility of larger resections for recurrent HNSCCs, these procedures are associated with significant morbidity [1,6,7] and economic costs [1,8]. These issues are important in consideration of cost-effectiveness.…”

Clinical potential of boron neutron capture therapy for locally recurrent inoperable previously irradiated head and neck cancer

“…A median survival of 9.7 months and 13.1 months for BNCTtreated patients with recurrent HNC was reported in two out of the 7 eligible trials (Kankaanranta et al, 2012;Suzuki et al, 2014). This is an improvement from an estimated lifespan of 6 months had these patients been offered supportive care only (Zafereo et al, 2009). Median survival could not be reported in the other 5 trials because a large proportion of the patients were still alive at the study end-point.…”

“…Only 2 studies reported on progression-free survival (up to 7.9 months) (Kankaanranta et al, 2012;Suzuki et al, 2014). This end-point is important for these patients, as head and neck tumours may cause a loss of organ function and cosmesis issues that may impair the patients' quality of life (Zafereo et al, 2009). Generally these radioresistant recurrent head and neck tumours, responded well to BNCT with at least 71.2% of the patients experiencing tumour shrinkage of more than 30% or complete disappearance of tumour.…”

Salvage operations for patients with persistent or recurrent cancer of the maxillary sinus after superselective intra-arterial infusion of cisplatin with concurrent radiotherapy

“…The complication rate of salvage surgery after intensive chemoradiation therapy for patients with head and neck cancer was reported to be 11%-63.2% [7][8][9][10].…”

“…Salvage surgery is generally attempted, when localized persistent or recurrent primary tumors are observed after initial chemoradiotherapy [9][10][11][12]. However, there have been no reports of salvage surgery for patients with persistent/recurrent maxillary sinus cancer after intensive chemoradiotherapy to date.…”