Salvage Surgery for Recurrence after Radiotherapy for Squamous Cell Carcinoma of the Head and Neck

Abstract

Objective Most studies that report on salvage surgery after primary radiotherapy for head and neck squamous cell carcinoma (HNSCC) are small and heterogeneous. Subsequently, some relevant questions remain unanswered. We specifically focused on (1) difference in prognosis per tumor subsite, corrected for disease stage, and (2) differences in prognosis after salvage surgery for local, regional, and locoregional recurrences. Study Design Retrospective analysis. Setting Single-center study (2000-2016). Subjects and Methods Patients treated with salvage surgery for HNSCC recurrence after (chemo)radiotherapy. Results In total, 189 patients were included. Five-year overall survival (OS) was 33%, and median OS was 18 (95% confidence interval [CI], 11-26) months. Treatment-related mortality was 2%. Larynx carcinoma was associated with more favorable local (adjusted hazard ratio [HR] = 4.02; 95% CI, 1.46-11.10; P = .007) and locoregional control (adjusted HR = 5.34; 95% CI, 1.83-15.61; P = .002) than pharyngeal carcinoma. American Society of Anesthesiologists (ASA) score (≥3 vs 1-2: adjusted HR = 3.04; 95% CI, 1.17-7.91; P = .023), pT stage (3-4 vs 1-2: adjusted HR = 4.41; 95% CI, 1.65-11.82; P = .003), and salvage surgery for locoregional recurrences (locoregional vs local: adjusted HR = 3.81; 95% CI, 1.13-11.82; P = .021) were independent predictors for disease-free survival (DFS). Conclusion Salvage surgery for larynx carcinoma, regardless of disease stage and other prognostic factors, results in more favorable loco(regional) control but not favorable DFS than pharyngeal carcinoma. The observed difference in DFS between salvage surgery for local and regional recurrences was not significant after correction for confounders. However, survival following salvage surgery for locoregional disease is significantly worse. For this subgroup, we propose to consider T status and comorbidity for clinical decision making, as high pT stage and ASA score are independent predictors for worse DFS.

The Reversal of Immune Exclusion Mediated by Tadalafil and an Anti-tumor Vaccine Also Induces PDL1 Upregulation in Recurrent Head and Neck Squamous Cell Carcinoma: Interim Analysis of a Phase I Clinical Trial

“…As controls we enrolled eligible patients willing to donate blood and tumor specimen but unwilling to receive study drugs. This cohort of patients was chosen because of the absence or the high morbidity of effective non-surgical treatments as alternatives to or adjuvant to standard of care salvage surgery, and the high recurrence rate (up to 70%) associated with salvage surgery alone in patients with recurrent, resectable, advanced staged HNSCC in a previously irradiated field (49). Even a small trial in this population might provide some insights regarding the clinical efficacy of an experimental treatment.…”

Outcomes of Primary Versus Salvage Surgery for Sinonasal Malignancies: A Population‐Based Analysis

“…In the setting of residual or recurrent disease for head and neck malignancies, SS may provide the best OS outcomes, despite the higher risk for complications, yet factors predicting OS remain not well defined 28 . In the setting of SS for head and neck SCC, predictors of regional control and DFS have been laryngeal (compared to pharynx) primary site, greater physical health, local disease recurrence, close/negative surgical margins, and early‐stage disease 29,30 . However, in a meta‐analysis of 729 patients undergoing SS, Elbers et al demonstrated that, primary site (i.e., larynx, oropharynx, hypopharynx, and oral cavity) was not a significant predictor in terms of OS outcomes for head and neck SCC 31 .…”

Salvage surgery in head and neck cancer

“…Therefore, he concluded that recurrent stage was a highly significant predictor of recurrence‐free survival where he could not confirm this for specific sites. The fact that stage means more than site has been supported by the majority of authors, with the important note that that data on non‐laryngeal advanced stage disease are sparse (Elbers et al., 2019; Hamoir et al, 2018; Pivot et al., 2001; van der Putten et al, 2015).…”

“…Outcome in recurrent hypopharyngeal SCC is inferior to recurrent laryngeal SCC. Complication rate is higher in salvage PL probably due to high percentage of prior chemotherapy and the notoriously poor outcome of hypopharynx cancer (Chung et al., 2019; Elbers et al., 2019; van der Putten et al, 2015). Van der Putten et al (2015) found a 5‐year OS of 27% for salvage (pharyngo)laryngectomy after primary chemoradiation (Figure 1).…”