Salvage surgery after failure of non surgical therapy for advanced head and neck cancer
Didier Dequanter, N. Vercruysse, M. Shahla, P. Paulus, Ph. Lothaire
DOI: 10.4236/ojst.2011.14029   PDF    HTML     5,036 Downloads   7,828 Views   Citations


Introduction: for organ and function preservation, chemoradiotherapy is gaining popularity for primary treatment of advanced head and neck cancer, re- serveing surgery for salvage. Methods: Retrospective outcome analysis to determine the results of salvage surgery after failure of primary treatment of advan- ced head and neck cancer by chemoradiotherapy. 104 patients with advanced head and cancer were initially treated by chemoradiotherapy. Follow-up was evalu- ated in 27 patients undergoing salvage surgery for re- current tumor (larynx n = 13; oral cavity n = 9; hypo- pharynx 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 morbi- dity 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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Dequanter, D. , Vercruysse, N. , Shahla, M. , Paulus, P. and Lothaire, P. (2011) Salvage surgery after failure of non surgical therapy for advanced head and neck cancer. Open Journal of Stomatology, 1, 189-194. doi: 10.4236/ojst.2011.14029.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Ganly, I., Patel, S.G., Matsuo, J., et al. (2006) Results of surgical salvage after failure of definitive radiation ther- apy for early-stage squamous cell carcinoma of the glot- tic larynx. Archives of Otolaryngology-Head & Neck Surgery, 132, 59-66. doi:10.1001/archotol.132.1.59
[2] Tenam, S., Koka, V. and Mamelle, G. (2005) Treatment of the N0 neck during salvage surgery after radiotherapy of head and neck squamous cell carcinoma. Head Neck, 27, 653-658. doi:10.1002/hed.20234
[3] Rickey, L.M., Shores, C.G., George, J., et al. (2007) The effectiveness of salvage surgery after failure of primary concomitant chemoradiation in head and neck cancer. Otolaryngology-Head and Neck Surgery, 136, 98-103. doi:10.1016/j.otohns.2006.06.1267
[4] Lee, S.C., Shores, C.G. and Weissler, M.C. (2008) Sal- vage surgery after failed primary concomitant chemoradia- tion. Current Opinion in Otolaryngology & Head and Neck Surgery, 16, 135-140. doi:10.1097/MOO.0b013e3282f495b6
[5] Taki, S., Homma, A., Oridate, N., Suzuki, S., et al. (2010) Salvage surgery for local recurrence after chemoradiother- apy or radiotherapy in hypopharyngeal cancer patients. European Federation of Oto-Laryngological, 267, 1765- 1769.
[6] Spriano, G., Pellini, R. and Romazno, G. (2002) Supracri- coid partial laryngectomy as salvage surgery after radiation failure. Head Neck, 24, 759-765. doi:10.1002/hed.10117
[7] Nibu, K., Kamata, S. and Kawabata, K. (1997) Partial laryngectomy in the treatment of radiation failure of early carcinoma. Head Neck, 19, 116-120. doi:10.1002/(SICI)1097-0347(199703)19:2<116::AID-HED5>3.0.CO;2-7
[8] Jorgensen, K., Godballe, C. and Hansen, O. (2002) Cancer of the larynx-treatment results after primary radiotherapy with salvage surgery in a series of 1005 patients. Acta Oncologica, 41, 69-76. doi:10.1080/028418602317314091
[9] Marchese-Ragona, R., Marioni, G. and Chiarello, G. (2005). Supracricoid laryngectomy with cricohyoidopexy for recurrence of early glottic carcinoma after irradiation: Long term oncological and functional results. Acta Otolaryngol, 125, 91-95. doi:10.1080/00016480410017927
[10] Rodriguez-Cuevas, S., Labastida, S., Gonzalez, D., et al. (1998) Partial laryngectomy as salvage surgery for radiation failures in T1-T2 laryngeal cancer. Head Neck, 20, 630-633. doi:10.1002/(SICI)1097-0347(199810)20:7<630::AID-HED9>3.0.CO;2-K
[11] Makeieff, M., Venegoni, D., Mercante, G., et al. (2005) Supracrociod partial laryngectomies after failures of radiation therapy. Laryngoscope, 115, 353-357. doi:10.1097/01.mlg.0000154751.86431.41
[12] Holsinger, F.C., Funk, E., Roberts, D.B., et al. (2006) Conservation laryngeal surgery versus total larynge- ctomy for radiation failure in laryngeal cancer. Head Neck, 28, 779-784. doi:10.1002/hed.20415
[13] Shamboul, K., Doyle-Kelly, W. and Bailey, D. (1984) Results of salvage surgery following radical radiotherapy for laryngeal carcinoma. Journal of Laryngology & Otology, 98, 905-907. doi:10.1017/S0022215100147681
[14] Kraus, D.H., Pfister, D.G. and Harrsion, L.B. (1995) Sal- vage laryngectomy for unsuccessful larynx preservation therapy. Annals of Otology, Rhinology, and Laryngology, 104, 936-941.
[15] Yao, M., Roebuck, J.C. and Holsinger, F.C. (2005) Elective neck dissection during salvage laryngectomy. American Journal of Otolaryngology, 26, 388-392. doi:10.1016/j.amjoto.2005.05.002
[16] Farrag, T.Y., Lin, F.R. and Cummings, C.W. (2006) Neck management in patients undergoing postradiotherapy salvage laryngeal surgery for recurrent/persistent laryngeal cancer. Laryngoscope, 116, 1864-1866. doi:10.1097/
[17] Homma, A., Furuta, Y. and Oridate, N. (2006) Watch and see policy for the clinically positive neck in head and neck cancer treated with chemoradiotherapy. Interna- tional Journal of Clinical Oncology, 11, 441-448. doi:10.1007/s10147-006-0603-4
[18] Dequanter, D., Lothaire, P. and Awada, A. (2006) Does clinical and radiological response predict complete tumor control in N2-N3 squamous cell head and neck cancer after non operative management of the neck? Acta Otolaryngol, 126, 1225-1228. doi:10.1080/00016480600818088
[19] Goguen, L.A., Posner, M.R. and Tishler, R.B. (2006) Examining the need for neck dissection in the era of chemoradiation therapy for advanced head and neck cancer. Archives of Otolaryngology-Head & Neck Surgery, 132, 526-531. doi:10.1001/archotol.132.5.526
[20] Schwartz, G.J., Mehta, R.H., Wenig, B.L., et al. (2000) Salvage treatment for recurrent squamous cell carcinoma of the oral cavity. Head Neck, 22, 34-41. doi:10.1002/(SICI)1097-0347(200001)22:1<34::AID-HED6>3.0.CO;2-3
[21] Gleich, L.L., Ryzenman, J., Gluckman, J.L., et al. (2004) Recurrent advanced (T3-T4) head and neck squamous cell carcinoma: Is salvage possible? Archives of Otolaryngology-Head & Neck Surgery, 130, 35-38. doi:10.1001/archotol.130.1.35
[22] Kim, A.J., Suh, J.D., Sercarz, J.A., et al. (2007) Salvage surgery with free flap reconstruction: Factors affecting outcome after treatment of recurrent head and neck squamous carcinoma. Laryngoscope, 117, 1019-1023. doi:10.1097/MLG.0b013e3180536705
[23] Wong, L.Y., Wei, W.I., Lam, L.K., et al. (2003) Salvage recurrent head and neck squamous cell carcinoma after primary curative surgery. Head Neck, 25, 953-959. doi:10.1002/hed.10310
[24] Goodwin, W.J. (2000) Salvage surgery for patients wit recurrent squamous cell carcinoma of the upper digestive tract: When do the ends justify the means? Laryngoscope, 110, 1-18. doi:10.1097/00005537-200003001-00001
[25] Yom, S.S., Machtay, M., Biel, M.A., et al. (2005) Sur- vival impact of planned restaging and early surgical salvage following definitive chemoradiation for locally advanced squamous cell carcinomas of the oropharynx and hypopharynx. American Journal of Clinical Oncology, 28, 385-392. doi:10.1097/01.coc.0000162422.92095.9e
[26] Leon, X., Quer, M., Orus, C., et al. (2001) Results of salvage surgery for local or regional recurrence after larynx preservation with induction chemotherapy and radiotherapy. Head Neck, 23, 733-738. doi:10.1002/hed.1104
[27] Stoeckli, S.P., Pawlik, A.B., Lipp, M., et al. (2000) Salvage surgery after failure of nonsurgical therapy for carcinoma of the larynx and hypopharynx. Archives of Otolaryngology-Head & Neck Surgery, 126, 1473-1477.
[28] Lavertu, P., Bonafede, J.P. and Adelstein, D.J. (1998) Comparison of surgical complications after organ preservation therapy in patients with stage III or IV squamous cell head and neck cancer. Archives of Otolaryngology-Head & Neck Surgery, 124,401-406
[29] Clark, J.R., De Almeida, J., Gilbert, R., et al. (2004) Primary and salvage (hypo) pharyngectomy: Analysis and outcome. Head Neck, 26, 272-277.
[30] Wakisaka, N., Murono, S.K., et al. (2008) Postoperative pharyngocutaneous fistula after laryngectomy. Auris Nasus Larynx, 35, 203-208. doi:10.1016/j.anl.2007.06.002
[31] Johansen, L.V., Overgaard, J. and Elbrond, O. (1988) Pharyngocutaneous fistulae after laryngectomy: Influence of previous radiotherapy and prophylactic metronidazole. Cancer, 61, 673-678. doi:10.1002/1097-0142(19880215)61:4<673::AID-CNCR2820610410>3.0.CO;2-C
[32] Dedo, D.D., Alonso, W.A. and Ogura, J.H. (1975) Inci- dence, predisposing factors and outcome of pharyngocutaneous fisutlas complicating head and neck surgery. Annals of Otology, Rhinology, and Laryngology, 84, 833-840.
[33] McCombe, A.W. and Jones, A.S. (1993) Radiotherapy and complications of laryngectomy. Journal of Laryngo- logy & Otology, 107, 130-132. doi:10.1017/S0022215100122406
[34] Agra, I.M., Carvalho, A.L., Pontes, E., et al. (2003) Postoperative complications after en bloc salvage surgery for head and neck. Archives of Otolaryngology-Head & Neck Surgery, 129, 1317-1321. doi:10.1001/archotol.129.12.1317

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