Tumour Recurrence in Squamous Head and Neck Cancer (original) (raw)
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Squamous cell carcinoma of the oropharynx
Cancer, 2002
BACKGROUND. The treatment of patients with squamous cell carcinoma (SCC) of the oropharynx remains controversial. No randomized trial has addressed adequately the question of whether surgery (S), radiation therapy (RT), or combined treatment is most effective.
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.
Journal of Cancer Science & Therapy, 2011
Objective: Second primary tumours (SPT) have been implicated in the dismal overall survival (OS) of head and neck Squamous cell carcinomas (HNSCC). The incidence of SPT, the SPT diagnostic time-lag and the impact on OS were assessed. Subjects and methods: 363 consecutive patients treated for primary oral SCCs (1967-2004) were analyzed retrospectively in this study. 95.1% and 90.5% of patients reached a minimum follow-up period of 3 and 5 years respectively. Results: Of 363 patients; 68 (18.7%) were diagnosed with metachronous SPT, 49 (13.5%) developed upper aerodigestive tract (UAD)-SPT, 28 (7.7%) were diagnosed with HNSCC-SPT, and 21 (5.8%) developed lung or esophageal carcinoma. Patients with subsequent HNSCC-SPT had a better median survival during follow-up than those not diagnosed with SPTs (p=0.0018). The rate of mortality in these patients showed a substantial increase compared to patients with no subsequent SPT Diagnosis after 144 months. After 200 months the survival experience was no better than those without SPT. Conclusion: These results suggest a better OS for patients afflicted with HNSCC-SPT. This also reflects that at least some of the noted improved OS of HNSCC-SPT patients is due to temporally cumulated risk associated with developing SPT.
Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgery
Head & Neck, 2003
Purpose. The efficacy of salvage treatment of recurrent head and neck squamous cell carcinomas (HNSCC) after primary curative surgery was evaluated. Methods. The management outcome of 377 patients who had recurrent squamous cell carcinoma of oral cavity, oropharynx, hypopharynx, and larynx after primary curative surgery was reviewed. Results. The surgical salvage rates of recurrence were 29% local, 30% tracheostomal, 56% unilateral nodal recurrence of previously undissected neck, 32% of unilateral neck recurrence after prior neck dissection, and 11% lung metastasis. The 5-year tumor-free actuarial survival rates of those patients who received surgical salvage was 35% for local recurrence, 32% for unilateral nodal recurrence of the previously undissected neck, and 18% for nodal recurrence of the previously dissected neck. One patient of six with tracheostomal recurrence salvaged with surgery and one patient of six with lung metastasis salvaged with lobectomy survived without tumor at 5 years. There was no 5-year survivor of all patients salvaged with other nonsurgical methods. The mean survival of patients without surgical salvage was 6 months. Conclusions. There was a moderate chance of cure after surgical salvage of locoregional recurrent HNSCC. Surgical salvage was, however, only feasible for early recurrent tumor. Close follow-up surveillance of early recurrence is essential after primary treatment of patients.
Head and Neck Cancers, Version 2.2014
Journal of the National Comprehensive Cancer Network
This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck (H&N) Cancers focuses on glottic laryngeal cancer, which is the most common type of laryngeal cancer and has an excellent cure NCCN
Head and Neck Cancers, Version 1.2015
Journal of the National Comprehensive Cancer Network, 2015
This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck (H&N) Cancers focuses on glottic laryngeal cancer, which is the most common type of laryngeal cancer and has an excellent cure NCCN
2000
Cancers of the head and neck include a variety of tumors of different histology and behavior. The different subtypes represented by these tumors include squamous cell cancers, paranasal sinus cancers, nasopharyngeal carcinomas, salivary gland cancers, thyroid gland malignancies, melanomas, sarcomas, small cell neuroendocrine carcinoma, and lymphomas. By far the most commonly encountered cancers in this group, accounting for more than 90% of tumors, are the squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx, larynx, and paranasal sinuses. This chapter concentrates on squamous cell carcinoma of the head and neck (SCCHN), nasopharyngeal carcinoma (NPC), and cancers of the salivary glands
Squamous cell carcinomas of the head and neck: descriptive analysis of 1293 cases
The Journal of Laryngology & Otology, 1997
Medical reports of 1293 patients with squamous cell carcinoma (SCC) of the head and neck were retrospectively evaluated. The patients were classified according to their age, sex, primary tumour localization and tumoral stage. There were 1181 males (91.3 per cent) and 112 females (8.7 per cent), with a male to female ratio of 10.5:1. The peak incidences for all primary tumour localizations were observed in the fifth decade. Most common primary tumour localizations were the larynx (71.1 per cent), the nasopharynx (10.1 per cent) and the oral cavity (8.8 per cent). Of all patients in whom staging was complete, 43.1 per cent presented at early and 56.9 per cent at advanced stages. The proportion of patients presenting with metastatic neck nodes was 34.4 per cent and the incidence of metastatic neck nodes increased with increasing T stage. The supraglottic region was the most common primary site among all laryngeal SCC, with a supraglottic to glottic SCC ratio of 1.5:1. Glottic SCC presented at earlier stages compared to supraglottic SCC. The incidence of nodal metastases increased with increasing T stage for SCC of the larynx, the oral cavity and the oropharynx.
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...
Treatment outcomes of unknown primary squamous cell carcinoma of the head and neck
PLOS ONE, 2018
Treatment modality of unknown primary squamous cell carcinoma of the head and neck (SCCHN) remains controversial. To evaluate the treatment outcomes and prognostic factors of unknown primary SCCHN. Patients with unknown primary SCCHN from April 1995 to March 2013 were recruited retrospectively. Sixty-nine patients were enrolled. The median time of follow-up was 55.5 months. The 2year loco-regional control rate of all the patients was 60.4%. Multivariate Cox regression analysis revealed that N3 stage, extracapsular spread, distant metastasis, and treatment modality were significantly associated with neck recurrence. The actuarial 5-year diseasespecific survival rates of neck dissection, neck dissection plus adjuvant therapy, radiotherapy alone, and combined therapy were 80.0%, 61.7%, 33.3%, and 68.8%, respectively (p = 0.046). The 5-year disease-specific survival rates of N1/N2a, N2b/N2c, and N3 stage were 83.9%, 64.3%, and 36.7%, respectively (p = 0.013). Univariate regression analysis revealed that neck recurrence, supraclavicular node involvement, distant metastasis, N3 stage, and unhealthy lifestyle habits were correlated with disease-specific mortality, especially the first three parameters. Patient's occupation and comorbidity were not significantly correlated with survival.