The effectiveness of salvage surgery after the failure of primary concomitant chemoradiation in head and neck cancer

Richey, Luke M.; Shores, Carol G.; George, Julia D.; Lee, Steve C.; Couch, Marion; Sutton, D. K.; Weissler, Mark C.

doi:10.1016/j.otohns.2006.06.1267

Cited by 63 publications

(62 citation statements)

References 18 publications

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“…Despite the generalized use of CCRT, few studies have specifically analyzed the results of salvage surgery in case of failure after this treatment [8,11,12]. We present the results of a group of 70 patients with advanced HNSCC with a local and/or regional recurrence treated with CCRT.…”

Section: Discussionmentioning

confidence: 99%

“…Two-year adjusted survival in HNSCC patients treated with salvage surgery after CCRT failure reviewed by Richey et al [12] and Tan et al [8] was 27.5 and 43.4%, respectively. In a study by Weber et al [11] including only patients with laryngeal carcinoma treated with CCRT, locoregional control obtained with salvage surgery after local failure was 74%.…”

Section: Discussionmentioning

confidence: 99%

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Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

Esteller

Vega

López

et al. 2010

Eur Arch Otorhinolaryngol

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With the increasing use of concomitant chemoradiotherapy (CCRT) in the treatment of advanced head and neck carcinoma, surgery has lost ground as the first therapy and is reserved as a salvage treatment in cases of locoregional failure. The objective of our study was to review our experience in patients who had a local or regional recurrence after treatment with CCRT. Thirty-two patients underwent salvage surgery after CCRT: 24 were treated with a local or locoregional resection and 8 patients with a neck dissection only. In patients who had surgery involving the primary location of the tumor, some kind of reconstruction was required in 83% of cases. One or more postoperative complications occurred in nine patients. The median hospital stay was 18.5 days. There was a significant difference in hospital stay in relation to the appearance of surgical complications. Five-year adjusted survival after salvage surgery was 34.2% (CI 95% 13.2-55.2%). Adjusted survival was related to the status of the resection margins and appearance of neck nodes with extracapsular spread in the neck dissection. In conclusion, salvage surgery after CCRT involves extensive resections, requiring reconstruction techniques with regional or microanastomosed free flaps in most cases, achieving acceptable outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

Esteller

Vega

López

et al. 2010

Eur Arch Otorhinolaryngol

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“…However, in recent decades, partial laryngectomy has been used successfully in such patients [3,4]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…The two main aspects for an analysis concern the oncological outcome on one hand and the morbidity on the other hand. Both have been reported with broad variation in results among different groups [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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

Dequanter¹,

Vercruysse²,

Shahla³

et al. 2011

OJST

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Introduction: for organ and function preservation, chemoradiotherapy is gaining popularity for primary treatment of advanced head and neck cancer, reserveing surgery for salvage. Methods: Retrospective outcome analysis to determine the results of salvage surgery after failure of primary treatment of advanced head and neck cancer by chemoradiotherapy. 104 patients with advanced head and cancer were initially treated by chemoradiotherapy. Follow-up was evaluated in 27 patients undergoing salvage surgery for recurrent tumor (larynx n = 13; oral cavity n = 9; hypopharynx n = 5). The initial tumor is stage T3 in 11 cases and T4 in 16 cases. 10 patients had primary tumors stage III and 17 patients had tumors stage IV. Results: One postoperative death occured following surgery. The overall incidence of complications was 9/ 27 (%). Recurrent disease developed at the primary initially treated in 25 cases and in the neck in 2 cases after a mean follow-up of 11 months (3 -136 months). After salvage surgery, loco-regional recurrence and/ or distant disease developed in 10/27 patients after a mean follow-up of 4 months. 6/10 (60%) patients died after re-recurrence despite salvage chemotherapy. Conclusion: Salvage surgery after failure of initial chemoradiotherapy is burdened with high morbidity and bad oncological outcome. We demonstrated that it is difficult to salvage locally recurrent head and neck cancer especially at more advanced T-stages or when tumor recur. The limited effect of surgical salvage for recurrent tumor need to be addressed when choosing the initial treatment plan.

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“…A limited number of patients with recurrent disease are candidates for salvage therapies, including potentially curative surgery. 63 Some patients in this setting appear to benefit from re-irradiation although the morbidities of this approach can be substantial and careful patient selection is key. 64 Chemotherapy therefore remains the mainstay of treatment for the majority of patients with incurable HNSCC.…”

Section: Treatment Of Recurrent or Metastatic Diseasementioning

confidence: 99%

The contribution of cetuximab in the treatment of recurrent and/or metastatic head and neck cancer

Tejani

Cohen²,

Mehra

2010

BTT

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Recurrent and/or metastatic squamous cell carcinoma of the head and neck (HNSCC) continues to be a source of significant morbidity and mortality worldwide. Agents that target the epidermal growth factor receptor (EGFR) have demonstrated beneficial effects in this setting. Cetuximab, a monoclonal antibody against the EGFR, improves locoregional control and overall survival when used as a radiation sensitizer in patients with locoregionally advanced HNSCC undergoing definitive radiation therapy with curative intent. Cetuximab is also active as monotherapy in patients whose cancer has progressed on platinum-containing therapy. In the first-line setting for incurable HNSCC, cetuximab added to platinum-based chemotherapy significantly improves overall survival compared with standard chemotherapy alone. These positive results have had a significant impact on the standard of care for advanced HNSCC. In this review, we will discuss the mechanism of action, clinical data and common toxicities that pertain to the use of cetuximab in the treatment of advanced incurable HNSCC.

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The effectiveness of salvage surgery after the failure of primary concomitant chemoradiation in head and neck cancer

Cited by 63 publications

References 18 publications

Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

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

The contribution of cetuximab in the treatment of recurrent and/or metastatic head and neck cancer

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