Rapid recurrence in head and neck cancer: Underappreciated problem with poor outcome

Abstract

Background: Rapid recurrence, defined as gross tumor recurrence after primary operation but prior to initiating postoperative radiation therapy (PORT), is underappreciated in head and neck cancer (HNC). Methods: CT simulation images in patients with HNC managed surgically with adjuvant therapy at a single center between 2010 and 2017 were retrospectively reviewed. Results: A total of 194 patients with HNC were included. Rapid recurrence occurred in 39 patients (20%) with a median time from operation to CT simulation of 37 days. On multivariable analysis (MVA), extranodal extension (ENE) was the only predictor of rapid recurrence (P = .03). While rapid recurrence, ENE, and perineural invasion were all associated with poor overall survival (OS) on MVA, rapid recurrence was the strongest predictor (hazard ratio [HR] 5.47). Conclusion: Rapid recurrence occurs at an underappreciated rate and is associated with poor survival outcomes. Patients with ENE are at highest risk and may benefit from diagnostic imaging evaluations immediately prior to PORT.

Salvage surgery for patients with residual/persistent diseases after improper or insufficient treatment of oral squamous cell carcinoma: can we rectify these mistakes?

“…For the treatment of resectable residual/persistent diseases, there were still unsettled controversies about the role and outcomes of SS, with vastly conflicting survival outcomes ranging from 8.3 to 62.5% [ 6 , 10 , 11 , 47 ]. Most of these studies were with mingled residual/persistent and recurrent OSCC cases, within whom a higher proportion of patients were found with histories of prior radiotherapy or chemoradiation [ 4 , 31 , 47 ].…”

“…However, the vague definition of “recurrences” in most reports have confused two groups of patients, residual/persistent and recurrent, who were drastically distinct in terms of clinical characteristics and prognoses, as patients with residual diseases were mostly those with initial positive margins [ 5 ]. Even within the so-called “recurrent” patients, some were however actually suffered from unabating/persistent painful symptoms right after initial resections, indicative of vastly inappropriate treatment, though with questionable prior reports of “negative” margins [ 6 , 7 ]. From our perspective, despite the initial curative intent, most cases with positive margins or persistent symptoms (confirmed by biopsies) should be regarded as “residual/persistent”, rather than “recurrent” OSCCs, on account of their insufficient prior treatment, and the unexpected survival loss accompanying abrupt changes of pre-decided treatment plans [ 8 ].…”

Salvage Surgery for Patients With Residual Diseases After Improper or Insufficient Treatment of Oral Squamous Cell Carcinoma: Can We Rectify These Mistakes?

“…For the treatment of resectable residual diseases, there were still unsettled controversies about the role and outcomes of SS, with vastly con icting survival outcomes ranging from 8.3-62.5% 6,10,36,37 . Most of these studies were with both residual and recurrent OSCC cases, which were further complicated by a higher proportion of patients with histories of prior radio-or radio-chemotherapies 6,37 . We came up with the rst report for the outcomes of immediate SS-based treatment against residual OSCCs, who were mostly radiation-naive.…”

“…were mostly those with initial positive margins 5 . Even within the so-called "recurrent" patients, some were however actually suffered from unabating painful symptoms right after initial resections, indicative of vastly inappropriate treatment, though with questionable prior reports of "negative" margins 6,7 . From our perspective, despite the initial curative intent, most cases with positive margins or persistent symptoms (con rmed by biopsies) should be regarded as "residual", rather than "recurrent" OSCCs, on account of their vastly insu cient prior treatment.…”

Rapid recurrence in postoperative head and neck cancer: Underappreciated or overcalled problem?

“…We read the recently published article by Lee et al 1 "Rapid recurrence in head and neck cancer: Underappreciated problem with poor outcome," with interest. The authors reported 20% (39/194 patients) rapid recurrence rate on computed tomography (CT) simulation images in patients with head and neck cancer postsurgically.…”