Surgical rescue for persistent head and neck cancer after first-line treatment

Abstract

Purpose Surgical rescue is a treatment option for persistent disease after first-line treatment treatment of head and neck cancer (HNC). Methods Patients with persistent HNC treated with rescue surgery between 2008 and 2016 were included. Patients who received a rescue neck dissection (ND only) and who received primary site surgery ± ND were analysed separately (primary site surgery ± ND). Results During the observation period, 35 patients received ND only and 17 primary site surgery ± ND. No perioperative mortality was observed. In nine patients with ND only and 12 patients with primary site surgery ± ND at least one complication was encountered. 41/52 (79%) patients had a complete response. Median overall survival of patients receiving rescue surgery was 56 months (95% CI 44-69 months). Median overall survival was best for patients with initial laryngeal and oropharyngeal cancer and worst for patients with hypopharyngeal cancer (p = 0.02). Functional deficits following rescue surgery were mainly observed in the domains speech, nutrition, and shoulder/arm mobility. The risk of functional impairment was higher for patients with rescue surgery at the primary tumor site (OR 2.5 ± 2; p = 0.07). Conclusion Rescue surgery offers patients with resectable, persistent disease a realistic chance to achieve long-term survival. Especially patients with laryngeal and oropharyngeal cancer profited from rescue surgery. Rescue neck dissection is an effective and safe procedure. Patients with rescue surgery at the primary tumor site ± ND should expect complications and permanent functional impairment.

Shoulder function after neck dissection: Assessment via a shoulder-specific quality-of-life questionnaire and active shoulder abduction

“…Furthermore, in the present study, a history of head and neck irradiation meant that the ND was basically a salvage operation after RT or chemo-RT. Poor shoulder function after salvage ND has been reported previously [37] , and our results were consistent with this. Post-RT planned selective or super-selective ND for human papilloma virus-related oropharyngeal cancer has recently been reported [38] .…”

The Epithelial-Mesenchymal Transcription Factor Slug Predicts Survival Benefit of Up-Front Surgery in Head and Neck Cancer

“…Surgical treatment poses specific additional risks for the patient. However, in about one-fourth of patients with HNSCC, primary RT/CRT fails and the disease persists, often requiring distressing salvage treatments [ 4 , 5 ]. Moreover, persistent disease is associated with an increased risk for distant metastasis [ 6 ] and poor survival [ 4 ].…”

Response evaluation of cervical lymph nodes after chemoradiation in patients with head and neck cancer - does additional [18F]FDG-PET-CT help?

“…False negative results after RCT mean an undetected persistent disease that often progresses quickly and has an unfavorable prognosis if not treated. Most patients can be treated safely and effectively [23], but treatment becomes increasingly difficult the longer the time interval between RCT and post-RCT ND due to progressive radiation fibrosis [24]. If the ITB had simply adhered to the results of the [18F]FDG-PET-CT, the rate of false negatives would have increased from 1 to 4, so the post-RCT 3 of 13 patients would have been delayed ( Table 2).…”