Salvage surgery for local recurrence after chemoradiotherapy or radiotherapy in hypopharyngeal cancer patients

Abstract

This retrospective study aimed to assess the role of salvage surgery for local recurrence in hypopharyngeal cancer (HPC) patients who had received radiotherapy (RT) or concomitant chemoradiotherapy (CRT) as an initial treatment. The local recurrence rate, salvage rate after local recurrence and overall survival rate were investigated in 104 HPC patients who received treatment between 1991 and 2005. Local recurrence in the primary site was observed in 41 patients (rate, 39.4%) of whom only 12 could undergo further salvage surgery. Disease control was achieved in seven of these patients (successful salvage rate, 17.1%). The 5-year overall survival rate was 40.6% in the RT/CRT patient group and successful salvage rates for T1, T2, T3 and T4 primary disease were 33.3% (1/3), 20.0% (4/20), 16.7% (2/12) and 0% (0/6), respectively. Severe postoperative complications such as pharyngo-cutaneous fistula were seen in six patients (50.0%). Prognosis of patients with locally recurring HPC after RT/CRT is poor at any primary T-stage and the incidence of postoperative complication is relatively high. This should be taken into consideration when the initial treatment plan is decided and the choice of salvage surgery for such recurrent cases should be carefully determined.

Salvage surgery after failure of non surgical therapy for advanced head and neck cancer

“…In this series [5], when the recurrence became unequivocal, most T3 and T4 patients were considered unsuitable to receive surgical salvage. Only two patients of 18 patients (11%) who experienced local recurrence achieved long term survival after surgical salvage.…”

“…In their series, Taki et al [5] experienced severe postoperative complications including pharyngocutaneous fistulas in 25% of patients who underwent laryngopharyngectomy. Such complications could severely diminish the quality of life for patients.…”

“…However, it has been reported that the feasibility of salvages therapies following tumor recurrence is generally low. In his series, Taki et al [5] reported that the local recurrence rate of hypopharyngeal cancer was 43.7% in patients with T2 -T4 disease after treatment with RT (CT) but salvage surgery is often the only curative option for recurrent cancer.…”

“…There is evidence that salvage surgery following (chemo) radiotherapy for early stage laryngeal carcinoma gives better survival rates and enables more often partial resections than in the presence of advanced initial stages [5][6][7][8][9].…”

Hangeshashinto Improves the Completion Rate of Chemoradiotherapy and the Nutritional Status in Patients with Head and Neck Cancer

“…Radiation with high-dose cisplatin every 3 weeks remains the most standard regimen in clinical trials by US Cooperative Groups. However, the toxicity of this regimen is too severe for most Japanese patients to complete; therefore, our institute has introduced a regimen of radiation with weekly 40 mg/m 2 of cisplatin [3]. We have to date achieved good clinical outcomes with acceptable toxicity in terms of neutropenia and renal failure [4].…”