Salvage surgery of cervical recurrences after neck dissection or radiotherapy

Abstract

A series of 113 patients operated on in the period 1980-1989 for a neck recurrence from a head and neck cancer was studied. All patients had no other evidence of disease. The male/female ratio was 93/20, and the median age was 58 years (range 28-87). Previous treatment consisted of surgery (SG) +/- radiotherapy (RT) in 81 patients (SG group) and only RT in 32 (RT group): 59 cases presented a relapse in the treated neck and 54 in the contralateral side. All but one contralateral recurrences were in the SG group. Ten patients were lost to follow-up. The observed 5-year survival rate of the whole series was 29.2% (95% confidence interval, 0%-38%). Considering patients with ipsilateral recurrences, the 5-year disease-free survival rate was 38.7% (95% c.i., 28.7%-48.7%) and 27% (95% c.i., 18%-36%) for the SG and the RT group, respectively. The 5-year disease-free survival rate after SG for contralateral recurrences was 38.8% (95% c.i., 23.8%-53.8%). Dimension and mobility of the neck nodes were the only demonstrable prognostic factors.

Elective treatment of the neck in squamous cell carcinoma of the larynx: Clinical experience

“…In real practice, it has been generally agreed that survival is definitely better with elective treatment 9. The reason is related to a low salvage rate when the metastases, which are sometimes also inoperable, clinically appear 2, 6–8, 10–14…”

Significado prognóstico do linfonodo metastático N3 em carcinomas epidermóides de cabeça e pescoço

“…Mesmo com resposta completa no pescoço, a possibilidade de doença residual é alta e deve ser considerado o esvaziamento cervical sempre que possível. Narayan et al 3 reportam doença residual em 62% dos espécimes de esvaziamento pós-radioterapia em pacientes cujas metástases eram inicialmente maiores do que 4 cm. A indicação de esvaziamento cervical, nesta situação, também se justifica pela remota possibilidade de resgate de uma recidiva, porém exige que a doença esteja controlada no sítio primário.…”

Update of Assessment of Survival in Head and Neck Cancer after Regional Recurrence

“…Failure in the neck after definitive neck treatment offers poorer prognosis than local recurrence [3]. Recurrence after multimodal treatment, in turn, presents poor prognosis with long-term survival of less than 5% [4–7]. Recurrence in the neck can result from observation of the neck, inadequate regional treatment, or missed metastasis at the time of initial approach.…”