Factors predictive of successful outcome following salvage treatment of isolated neck recurrences

Abstract

Objective: The aim of this study was to evaluate the outcome and predictive factors for salvage treatment of isolated neck recurrence after primary curative surgery for head and neck squamous cell carcinoma (HNSCC).

Study design: Case series with chart review.

Setting: Head and neck cancer clinic in a tertiary care university hospital.

Subjects and methods: A retrospective study was conducted with 236 patients who developed a recurrence after primary curative surgery with or without radiotherapy for HNSCC.

Results: Isolated neck recurrence developed in 61 (26%) patients. Salvage treatment was offered to 49 patients, and the overall salvage rate was 33 percent (20 of 61). The salvage rate for the surgical salvage group was 46 percent (16 of 35) and 28 percent (4 of 14) for the nonsurgical salvage group (chemoradiation) (P = 0.14). The three-year overall survival rate was 36 percent for patients with surgical salvage and 12 percent for patients with nonsurgical salvage (P = 0.101). There were no survivors of the supportive care group (0 of 12). Univariate analysis of individuals with isolated neck recurrence showed that patients who had previous treatment with surgery alone, a disease-free time longer than one year, previous pathologic N- status, recurrence in the undissected neck, or recurrent N1 had significantly improved salvage time (P < 0.05). However, in multivariate analysis, the factors previous treatment with surgery alone and recurrent N1 submitted to the salvage treatment were independent predictors of a successful salvage of isolated neck recurrence.

Conclusion: Our results suggest that the ideal candidates for salvage neck treatment include those patients with recurrent N1 disease and those whose previous treatment was surgery only.