Prior chemoradiotherapy and pathological perineural invasion predict the survival outcomes of salvage surgery in head and neck squamous cell carcinoma (original) (raw)
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The Current Role of Salvage Surgery in Recurrent Head and Neck Squamous Cell Carcinoma
Cancers, 2018
Chemoradiotherapy has emerged as a gold standard in advanced squamous cell carcinoma of the head and neck (SCCHN). Because 50% of advanced stage patients relapse after nonsurgical primary treatment, the role of salvage surgery (SS) is critical because surgery is generally regarded as the best treatment option in patients with recurrent resectable SCCHN. Surgeons are increasingly confronted with considering operation among patients with significant effects of failed non-surgical primary treatment. Wide local excision to achieve clear margins must be balanced with the morbidity of the procedure, the functional consequences of organ mutilation, and the likelihood of success. Accurate selection of patients suitable for surgery is a major issue. It is essential to establish objective criteria based on functional and oncologic outcomes to select the best candidates for SS. The authors propose first to understand preoperative prognostic factors influencing survival. Predictive modeling bas...
Oral Oncology, 2017
Objective: Salvage surgery in recurrent SCCHN is associated with poor outcomes. This study aimed to better identify suitable surgical candidates and those at high risk of new recurrence. Materials and methods: Single-center retrospective analysis of 109 patients undergoing salvage surgery for recurrent SCCHN. Univariate and multivariate analyses were used to identify prognostic factors affecting disease-free survival (DFS). Results: The following factors showed a significant impact on DFS: Disease-free interval >6 months [HR 0.53; p = 0.04], age > 70 years [HR 0.26; p = 0.03], primary chemoradiotherapy [HR 2.39; p < 0.01] compared to radiotherapy, oropharynx [HR 5.46; p < 0.01] and hypopharynx [HR 3.92; p = <0.01] sites, compared to larynx, initial stage III [HR 7.10; p < 0.01] and stage IV [HR 4.13; p < 0.01], compared to stage I, locoregional recurrence [HR 4.57; p < 0.01], compared to local recurrence. Univariate analysis also identified significant postoperative predictors of poor DFS including flap reconstruction [HR 3.44; p < 0.01], postoperative complications [HR 2.09; p = 0.01], positive margins [HR 3.64; p < 0.01] and close margins [HR 3.83; p < 0.01]. On multivariate analysis, oropharynx site [HR 3.98; p < 0.01], initial stage III [HR 5.93; p < 0.01] and locoregional recurrence [HR 2.93; p = 0.04] were independent preoperative prognostic factors for DFS. Positive margins [HR 2.32; p = 0.04], close margins [HR 2.94; p = 0.02], extracapsular spread (ECS) [HR 4.04; p = 0.03] and postoperative complications [HR 3.64; p < 0.01] were independent postoperative prognostic factors. Conclusions: Patients with advanced primary nonlaryngeal tumor and locoregional recurrence have limited success with salvage surgery. Because patients with positive margins and ECS are at high risk of relapse, adjuvant treatment should be discussed.
Otolaryngology–Head and Neck Surgery, 2007
OBJECTIVE: To determine survival outcomes and locoregional control rates in patients with locoregional head and neck squamous cell cancer (HNSCC) who failed primary concomitant chemoradiation (CRT) intended for cure and underwent attempted surgical salvage. STUDY DESIGN AND SETTING: Design was a nonrandomized retrospective cohort study. Of 204 patients with HNSCC who received primary concomitant chemoradiation intended for cure between 1995 and 2004, 38 recurred and underwent attempted salvage surgery at a tertiary care academic center. RESULTS: Among the 38 patients undergoing surgical salvage, 12- and 24-month overall survival rates were 60 percent and 27 percent. Locoregional control at 24 months was 42 percent. Lower survival was seen with initial N3 disease ( P = 0.0115). Overall surgical morbidity was 24 percent. CONCLUSION/SIGNIFICANCE: The results of salvage surgery after failed chemoradiation for HNSCC are poor. Those with N3 disease fare least well. Patients should be well...
Salvage Surgery for Recurrence after Radiotherapy for Squamous Cell Carcinoma of the Head and Neck
Otolaryngology–Head and Neck Surgery, 2018
Objective Most studies that report on salvage surgery after primary radiotherapy for head and neck squamous cell carcinoma (HNSCC) are small and heterogeneous. Subsequently, some relevant questions remain unanswered. We specifically focused on (1) difference in prognosis per tumor subsite, corrected for disease stage, and (2) differences in prognosis after salvage surgery for local, regional, and locoregional recurrences. Study Design Retrospective analysis. Setting Single-center study (2000-2016). Subjects and Methods Patients treated with salvage surgery for HNSCC recurrence after (chemo)radiotherapy. Results In total, 189 patients were included. Five-year overall survival (OS) was 33%, and median OS was 18 (95% confidence interval [CI], 11-26) months. Treatment-related mortality was 2%. Larynx carcinoma was associated with more favorable local (adjusted hazard ratio [HR] = 4.02; 95% CI, 1.46-11.10; P = .007) and locoregional control (adjusted HR = 5.34; 95% CI, 1.83-15.61; P = .0...
Cancer, 2015
BACKGROUND: The current study was performed to report the long-term results of a trial comparing concurrent chemotherapy and radiotherapy (CCRT) with surgery and adjuvant radiotherapy (RT) in patients with stage III/IV nonmetastatic head and neck squamous cell carcinoma. METHODS: Patients with stage III/IV resectable head and neck squamous cell carcinoma were randomized to surgery followed by RT or CCRT. The trial was halted prematurely due to poor accrual. Human papillomavirus status was tested on archival material using polymerase chain reaction sequencing. RESULTS: Of the total of 119 patients, 60 patients were randomized to primary surgery (S arm) and 59 patients were randomized to CCRT (C arm). Human papillomavirus status was tested in 75 patients, and only 3 were found to be positive. The median follow-up for surviving patients was 13 years. Analysis of the entire cohort demonstrated no statistically significant difference in overall survival and disease-specific survival (DSS): 5-year rates were 45% versus 35% for overall survival (P 5.262) and 56% versus 46% for DSS (P 5.637) for the S arm and C arm, respectively. Analysis by subsites indicated that this difference favoring the S arm was mainly driven by survival data among patients with cancers of the oral cavity and maxillary sinus. For patients with oral cavity cancer, survival was significantly better in those who underwent primary surgery compared with CCRT; the 5-year DSS rate was 68% versus 12% for the S arm and C arm, respectively (P 5.038). For patients with cancers of the maxillary sinus, the 5-year DSS rate was 71% for patients on the S arm and 0% for patients on the C arm (P 5.05). CONCLUSIONS: These long-term results demonstrate a significant advantage for primary surgery in patients with cancers of the oral cavity or maxillary sinus, providing strong support for primary surgery as the main modality of treatment for these subsites. In other subsites, CCRT and surgery with adjuvant RT were found to demonstrate similar efficacy for survival in patients with advanced resectable tumors. Cancer 2015;
Scientific Reports, 2021
Salvage surgery in recurrent head and neck squamous cell carcinoma has a poor outcome, both in terms of survival and quality of life. Therefore, the identification of pre-operative prognostic factors to improve the selection of patients who could benefit the most from salvage surgery is clinically relevant. The present study is a single-center retrospective analysis of 164 patients treated with salvage surgery after recurrence of head and neck cancer. Progression free survival and overall survival were calculated through Kaplan–Meier method. Hazard risk (HR) and corresponding confidence intervals (CI) were estimated through Cox proportional hazard model, adjusting for potential confounders. Significant predictors were combined into a prognostic score, attributing one point to each factor. Progression-free survival and overall survival were respectively 50.3% and 56.5% at 2 years, and 36.6% and 44.2% at 5 years. Four pre-operative factors were independently associated with poor progn...