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. 2011 Jun;13(2):29.

Salvage Resection for Isolated Local and/or Regional Failure of Head/Neck Cancer Following Definitive Concurrent Chemoradiotherapy Case Series and Review of the Literature

Patricia L Kearney, John M Watkins, Keisuke Shirai, Amy E Wahlquist, John A Fortney, Elizabeth Garrett-Mayer, M Boyd Gillespie, Anand K Sharma

Salvage Resection for Isolated Local and/or Regional Failure of Head/Neck Cancer Following Definitive Concurrent Chemoradiotherapy Case Series and Review of the Literature

Patricia L Kearney et al. Mcgill J Med. 2011 Jun.

Abstract

Background: Primary management of advanced head/neck cancers involves concurrent chemoradiotherapy . Subsequently, regional and local failures are managed with resection but there have been few reports that describe the morbidity and disease control outcomes of surgical salvage in this setting.

Methods: Retrospective analysis describes complications, survival, and patterns of failure after salvage resection of isolated local and/or regional failures of head/neck cancer following definitive concurrent chemoradiotherapy.

Results: Sixteen patients were identified for inclusion: laryngectomy in 11 patients, oral cavity/oropharynx resection in 2 patients, and neck dissection alone in 4 patients. Ten patients required graft tissue reconstruction (6 pedicle and 4 free flap). Median post-operative hospitalization was 7 days (range 3-19), and 4 patients required hospital re-admission. At a median survivor follow-up of 15.8 months (range 4.3-34.9), 10 patients were alive (6 without evidence of disease). Seven patients experienced disease recurrence at a median 6.7 months (range 0-12.6) following salvage resection (2 with isolated distant failures). Estimated 2-year local/regional control, freedom from failure, and overall survival were 58%, 39%, and 58%, respectively.

Conclusions: Surgical salvage after primary definitive concurrent chemoradiotherapy is feasible with toxicity and outcomes similar to prior radiotherapy alone or sequential chemotherapy and radiation. Local andregional recurrence remains the predominant pattern of failure.

Keywords: Combined modality therapy; Head and neck neoplasms; Organ preservation therapy; Salvage therapy.

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Figures

Figure 1:
Figure 1:
Locoregional control for salvage resection population. Fourteen patients at risk due to subtraction of two patients who died of treatment-associated toxicity within two weeks of salvage resection.
Figure 2:
Figure 2:
Freedom from disease failure for salvage resection population.
Figure 3:
Figure 3:
Overall survival for salvage resection population.
See this image and copyright information in PMC

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