Multidisciplinary evidence-based consensus statements on salvage surgery for recurrent head and neck cancer (International Centre for Recurrent head and neck Cancer)

Andrew Williamson^{1

2}, Grainne Brady³, Natalie Harris⁴, Puteri Abdul Haris⁵, Brian Bisase⁶, Kevin Chiu⁷, Catriona Douglas⁸, Jason Fleming⁹, David Hamilton¹⁰, Anoop Haridass¹¹, Ceri Hughes¹², Muhammad Shahid Iqbal¹³, Cyrus Kerawala¹⁴, Emma King¹⁵, Ziwei Liu¹⁶, James McCaul¹⁷, Jenny Montgomery⁸, Paul Nankivell¹⁸, Iain Nixon¹⁹, David Noble^{20

21}, Michael Nugent²², Claire Paterson²³, Paul Pracy¹⁸, Francesco Riva¹⁴, Justin Roe²⁴, Andrew Schache²⁵, Uthaya Selbong²⁶, Clare Schilling²⁷, Ricard Simo²⁸, Stuart Winter⁵, Ben O'Leary^{1

29}, Vinidh Paleri^{1

2}

Affiliations

¹ International Centre for Recurrent Head and Neck Cancer, The Royal Marsden Hospital, London, UK.
² The Institute for Cancer Research, London, UK.
³ Department of Speech, Voice and Swallowing, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, London, UK.
⁴ Department of Nutrition and Dietetics, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, London, UK.
⁵ Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁶ Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, East Grinstead, UK.
⁷ Department of Head and Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK.
⁸ ENT Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK.
⁹ Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
¹⁰ ENT Department, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
¹¹ Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
¹² University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK.
¹³ Clinical Oncology Department, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
¹⁴ Department of Head and Neck Surgery, The Royal Marsden Hospital, London.
¹⁵ University Hospitals Dorset NHS Foundation Trust and University of Southampton, UK.
¹⁶ Department of Head and Neck Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
¹⁷ Oral and Maxillofacial Surgery Department, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK.
¹⁸ ENT Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹⁹ Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, UK.
²⁰ Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK.
²¹ Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK.
²² Department of Oral and Maxillofacial Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
²³ Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow.
²⁴ Department of Speech, Voice, and Swallowing, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, London, UK.
²⁵ Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
²⁶ Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
²⁷ Head and Neck Academic Centre, Department of Head and Neck Surgery, University College London Hospital, London, UK.
²⁸ Division of Surgical Oncology, Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
²⁹ Evolution & Translational Genomics, The Institute of Cancer Research, London, UK.

PMID: 40515663
DOI: 10.1093/jnci/djaf128

Multidisciplinary evidence-based consensus statements on salvage surgery for recurrent head and neck cancer (International Centre for Recurrent head and neck Cancer)

Andrew Williamson et al. J Natl Cancer Inst. 2025.

. 2025 Jun 14:djaf128.

doi: 10.1093/jnci/djaf128. Online ahead of print.

Authors

Affiliations

¹ International Centre for Recurrent Head and Neck Cancer, The Royal Marsden Hospital, London, UK.
² The Institute for Cancer Research, London, UK.
³ Department of Speech, Voice and Swallowing, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, London, UK.
⁴ Department of Nutrition and Dietetics, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, London, UK.
⁵ Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁶ Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, East Grinstead, UK.
⁷ Department of Head and Neck Oncology, Mount Vernon Cancer Centre, Northwood, UK.
⁸ ENT Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK.
⁹ Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
¹⁰ ENT Department, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
¹¹ Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
¹² University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK.
¹³ Clinical Oncology Department, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
¹⁴ Department of Head and Neck Surgery, The Royal Marsden Hospital, London.
¹⁵ University Hospitals Dorset NHS Foundation Trust and University of Southampton, UK.
¹⁶ Department of Head and Neck Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
¹⁷ Oral and Maxillofacial Surgery Department, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK.
¹⁸ ENT Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹⁹ Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, UK.
²⁰ Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK.
²¹ Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK.
²² Department of Oral and Maxillofacial Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
²³ Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow.
²⁴ Department of Speech, Voice, and Swallowing, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, London, UK.
²⁵ Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
²⁶ Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
²⁷ Head and Neck Academic Centre, Department of Head and Neck Surgery, University College London Hospital, London, UK.
²⁸ Division of Surgical Oncology, Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
²⁹ Evolution & Translational Genomics, The Institute of Cancer Research, London, UK.

PMID: 40515663
DOI: 10.1093/jnci/djaf128

Abstract

Background: Recurrent head and neck squamous cell carcinomas (rHNSCC) are an understudied subgroup, lacking high quality evidence and thus gold standard management recommendations, resulting in significant variations in practice. The aim of this project was to deliver a national multi-disciplinary expert consensus on patients with rHNSCC managed by curative salvage surgery.

Methods: The AGREEII protocol guided the Delphi process. Best practice statements were developed after literature review on the perioperative management and surgical salvage of major rHNSCC subsites. Members of the International centre for Recurrent head and neck cancer (IREC) network, and other UK based professional stakeholder organisations were invited into an online Delphi study. Participants voted upon statements over three rounds, with items modified in response to vote thresholds and comments.

Results: Twenty-eight experts participated including 11 otolaryngologists, 7 oncologists, 9 oral and maxillofacial surgeons, and 1 speech and language therapist. Consensus was achieved on 73 statements, with 29 (39.7%) achieving unanimous (threshold: 100%) and 25 (34.2%) (threshold >90%) agreement.

Conclusions: Salvage surgery for rHNSCC are challenging cases that require intensive multidisciplinary input to achieve cure while balancing impact on function and quality-of-life. In this article, we provide a large series of statements based on UK-wide expert consensus, that will guide clinicians through the complex intra- and perioperative management of patients undergoing surgical salvage.

© The Author(s) 2025. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Multidisciplinary evidence-based consensus statements on salvage surgery for recurrent head and neck cancer (International Centre for Recurrent head and neck Cancer)

Affiliations

Multidisciplinary evidence-based consensus statements on salvage surgery for recurrent head and neck cancer (International Centre for Recurrent head and neck Cancer)

Authors

Affiliations

Abstract

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