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Jeong WJ, Jung YH, Kwon SK, Hah JH, Kwon TK, Sung MW, Kim KH. Role of Surgical Salvage for Regional Recurrence in Laryngeal Cancer. Laryngoscope 2007; 117:74-7. [PMID: 17202934 DOI: 10.1097/01.mlg.0000240184.75588.dc] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to analyze the pattern of regional recurrence in laryngeal cancer, evaluate the role of surgical salvage, and identify factors affecting salvage outcome. METHODS Retrospective analysis was conducted on medical records from a 16-year period. Of 463 patients diagnosed with laryngeal cancer, 25 patients with regional recurrence managed with salvage neck dissection were identified and subject to study. Isolated local recurrences and all distant metastases were excluded. RESULTS All patients were male with a median age of 61 years. The overall rate of regional recurrence was 5.4%. Median time to regional recurrence was 13 months. Isolated regional recurrence occurred in 76% of cases, whereas locoregional recurrence occurred in 24%. A 5-year survival rate for patients undergoing neck dissection as salvage management was 61.2%. Patients with recurrence in the contralateral neck were definitely associated with poor prognosis. Although standard statistical significance was not met, trends for poorer salvage result were identified in patients with a history of local recurrence before regional recurrence, recurrence in a previously dissected neck, and recurred node size of 3 cm or above. CONCLUSIONS Our study shows that salvage neck dissection for regional recurrence in laryngeal cancer is an acceptable approach. Surgical eradication of disease should be warranted whenever possible. Prudent planning of management is mandatory in the presence of history of local recurrence before regional recurrence, previously dissected neck, large size of recurrent node, and contralateral neck recurrence.
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Affiliation(s)
- Woo-Jin Jeong
- Department of Otolaryngology-Head & Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
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152
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Chen AM, Bucci MK, Singer MI, Garcia J, Kaplan MJ, Chan AS, Phillips TL. Intraoperative radiation therapy for recurrent head-and-neck cancer: the UCSF experience. Int J Radiat Oncol Biol Phys 2006; 67:122-9. [PMID: 17084543 DOI: 10.1016/j.ijrobp.2006.08.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 08/16/2006] [Accepted: 08/17/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To review a single-institutional experience with the use of intraoperative radiation therapy (IORT) for recurrent head-and-neck cancer. METHODS AND MATERIALS Between 1991 and 2004, 137 patients were treated with gross total resection and IORT for recurrence or persistence of locoregional cancer of the head and neck. One hundred and thirteen patients (83%) had previously received external beam radiation as a component of definitive therapy. Ninety-four patients (69%) had squamous cell histology. Final surgical margins were microscopically positive in 56 patients (41%). IORT was delivered using either a modified linear accelerator or a mobile electron unit and was administered as a single fraction to a median dose of 15 Gy (range, 10-18 Gy). Median follow-up among surviving patients was 41 months (range, 3-122 months). RESULTS The 1-year, 2-year, and 3-year estimates of in-field control after salvage surgery and IORT were 70%, 64%, and 61%, respectively. Positive margins at the time of IORT predicted for in-field failure (p = 0.001). The 3-year rates of locoregional control, distant metastasis-free survival, and overall survival were 51%, 46%, and 36%, respectively. There were no perioperative fatalities. Complications included wound infection (4 patients), orocutaneous fistula (2 patients), flap necrosis (1 patient), trismus (1 patient), and neuropathy (1 patient). CONCLUSIONS Intraoperative RT results in effective disease control with acceptable toxicity and should be considered for selected patients with recurrent or persistent cancers of the head and neck.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California, San Francisco, Comprehensive Cancer Center, San Francisco, CA.
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153
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Chopra S, Gupta T, Agarwal JP, Budrukkar A, Ghosh-Laskar S, Dinshaw K. Re-irradiation in the management of isolated neck recurrences: Current status and recommendations. Radiother Oncol 2006; 81:1-8. [PMID: 16971009 DOI: 10.1016/j.radonc.2006.08.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Revised: 07/28/2006] [Accepted: 08/21/2006] [Indexed: 11/21/2022]
Abstract
Recent times have witnessed significant improvements in outcome for head and neck squamous cell carcinomas. Nevertheless, the major pattern of failure continues to remain loco-regional. Isolated neck recurrence, although uncommon, occurs in 5-7% of patients after radical treatment. The options for this subgroup are somewhat limited and are often guided by empiricism rather than evidence. This review attempts to systematically analyze the therapeutic options for patients with isolated neck recurrence following radical treatment for the primary and draining cervical lymph nodes, with a special emphasis on re-irradiation. Salvage neck dissection offers the best chance of cure to patients with resectable neck recurrences. The perceived increased risk of complications of re-irradiation following previous curative dose irradiation has precluded optimal evaluation of its potential in this setting. Post-operative adjuvant re-irradiation should be based on histo-pathological findings of the salvage surgery. Re-irradiation with or without chemotherapy may be considered for unresectable neck recurrences. The role of chemotherapy continues to evolve and is presently not optimally defined. There is lack of high-quality evidence pertinent to salvage therapy leading to vast variations in practice. More patients with recurrent disease should be enrolled onto prospective clinical trials with relevant and meaningful endpoints.
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Affiliation(s)
- Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
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154
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Ord RA, Kolokythas A, Reynolds MA. Surgical Salvage for Local and Regional Recurrence in Oral Cancer. J Oral Maxillofac Surg 2006; 64:1409-14. [PMID: 16916677 DOI: 10.1016/j.joms.2006.05.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate local and regional recurrence and the outcomes for salvage surgery in patients for oral cancer. PATIENTS AND METHODS This study analyzed 354 consecutive patients with oral cancer treated primarily by surgery or surgery combined with adjuvant therapy by 1 surgeon (R.A.O.) between February 1991 and September 2001. RESULTS Overall recurrence rate was 15.5%; with 5.4% local, 8.5% regional, and 1.4% locoregional. Overall salvage for local recurrence was 52.6% 3-year survival, and statistically significant favorable prognostic factors were salvaged by surgery alone and initial cancer staging of I/II. Overall salvage for regional recurrence was 50%, with recurrence in a previously untreated neck and salvage with radical neck dissection plus radiotherapy giving the best prognosis. No patients with locoregional recurrence were salvaged. CONCLUSIONS Patients who were stage I/II and were treated initially by surgery alone were the best candidates for salvage if they recurred. Salvage was best achieved with surgery or surgery + adjuvant therapy, and patients recurring within 6 months had a worse survival. Patients with locoregional recurrence or treated with RT +/- chemotherapy alone have negligible survival.
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Affiliation(s)
- Robert A Ord
- Department of Oral and Maxillofacial Surgery, University of Maryland, Greenbaum Cancer Center, Baltimore, MD 21201-1754, USA
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155
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Koo BS, Lim YC, Lee JS, Choi EC. Recurrence and salvage treatment of squamous cell carcinoma of the oral cavity. Oral Oncol 2006; 42:789-94. [PMID: 16455287 DOI: 10.1016/j.oraloncology.2005.11.016] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 11/24/2005] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the incidence and predictive factors for recurrence of oral squamous cell carcinoma (SCC) and outcome according to salvage treatment modality. A retrospective analysis of 127 oral cavity cancer patients who underwent surgery with or without postoperative radiotherapy as initial treatment was performed. Thirty-six patients (28%) were observed with recurrences and/or metastases mostly at the primary site and neck. Seventy-eight percent of recurrences occurred within one year, and 92% within two years after the initial treatment. The rate of recurrence and/or metastases was significantly higher in patients with an advanced pathologic stage, pathologic lymph node and positive resection margin compared to those with an early pathologic stage, negative lymph node and negative resection margin (p<0.05). Especially, regarding the relationship between the rate of locoregional recurrence and local or regional factors, resection margin status was a particularly important, and potentially preventable, independent predictor for locoregional control. Patients who underwent salvage surgery with or without postoperative radiotherapy had significantly improved salvage and total survival times compared with patients who received chemotherapy and/or radiation therapy for their recurrence.
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Affiliation(s)
- Bon Seok Koo
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seodaemun-gu, 134 Shinchon-dong, Seoul, Republic of Korea
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156
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Raval MV, Zemon H, Kumar SS, Brody FJ. Laparoscopic splenectomy for metastatic squamous cell cancer of the neck. J Laparoendosc Adv Surg Tech A 2006; 15:383-6. [PMID: 16108741 DOI: 10.1089/lap.2005.15.383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Squamous cell carcinoma (SCC) spreads through direct extension, lymphatic vessels, and, rarely, hematogenous routes. The most common malignancies to metastasize to the spleen include carcinomas of the breast, lung, and melanoma. We present an unusual case of SCC of the neck with splenic metastases. The patient presented with a primary solid tumor of the neck that extended into the surrounding soft tissues, including the internal jugular vein and regional lymph nodes. A metastatic work-up with a positron emission tomograph showed enhancement in the left upper quadrant. A computed tomograph (CT) was then performed. The CT revealed three distinct splenic lesions, the largest measuring 6x6.5x2.5 cm. Subsequently, the patient was scheduled for a splenectomy. At the time of operation, diagnostic laparoscopy revealed only the splenic lesions. A laparoscopic splenectomy was performed successfully and the patient was started on a regular diet on postoperative day 1. This paper describes the first documented case of SCC of the neck with splenic metastases. The lesion was diagnosed and treated laparoscopically. The case is described in detail along with the clinical implications of this rare finding.
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Affiliation(s)
- Mehul V Raval
- Department of Surgery, George Washington University Medical Center, Washington, DC 20037, USA
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157
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Kunkel M, Helisch A, Reichert TE, Jeong JH, Buchholz HG, Benz P, Bartenstein P, Wagner W, Whiteside TL. Clinical and prognostic value of [(18)F]FDG-PET for surveillance of oral squamous cell carcinoma after surgical salvage therapy. Oral Oncol 2005; 42:297-305. [PMID: 16316775 DOI: 10.1016/j.oraloncology.2005.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Accepted: 08/09/2005] [Indexed: 10/25/2022]
Abstract
[(18)F]FDG-PET was found to be useful for recurrence detection in patients with oral squamous cell carcinoma (OSCC), as a negative PET scan predicted a favorable outcome and survival. Here, we evaluate PET performance in the management of OSCC patients with recurrent/second primary disease after potentially curative second-line therapy. Forty one OSCC patients underwent salvage surgery and 31/41 had received radiation therapy. Thirty five/41 developed recurrent and 6/41 second primary OSCC. Patients had PET evaluation 8.4months (median) after surgery and were followed for at least 6months until disease recurrence or death. For surviving patients, the median follow-up was 33.6months after PET. In OSCC patients who had undergone potentially curative second-line therapy, PET had an overall sensitivity of 85% (92% for recurrence or second primaries, 88% for lymph node failure and 73% for distant metastases). Overall survival was 71% in the PET negative group and 35% in the PET positive group (p<0.01, log-rank test). Moderate glucose metabolism (standardized uptake value4) suggested promising outcome, while SUV>4 indicated a fatal disease course. The data suggest that [(18)F]FDG-PET can facilitate re-staging and clinical management in "high-risk" patients with OSCC.
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Affiliation(s)
- Martin Kunkel
- Department of Oral and Maxillofacial Surgery, University Hospital Mainz, Augustusplatz 2, 55101 Mainz, Germany
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158
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Spring PM, Valentino J, Arnold SM, Sloan D, Kenady D, Kudrimoti M, Haydon RC, Lee C, Given C, Mohiuddin M, Regine WF. Long-term results of hyperfractionated radiation and high-dose intraarterial cisplatin for unresectable oropharyngeal carcinoma. Cancer 2005; 104:1765-71. [PMID: 16149090 DOI: 10.1002/cncr.21368] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In this report, the authors present the results from a study of patients with unresectable oropharyngeal squamous cell carcinomas who were treated on a protocol of hyperfractionated radiation and high-dose intraarterial cisplatin (HYPERRADPLAT) at the University of Kentucky. METHODS The study was designed as a prospective, single-armed case series that was conducted in the setting of a single, academic, tertiary referral center. The patient cohort consisted of 24 previously untreated patients who were diagnosed with unresectable oropharyngeal carcinoma and were treated on the HYPERRADPLAT regimen, which included hyperfractionated external beam radiotherapy (1.2 grays [Gy] twice daily) was given for 5 weeks (60 Gy) followed by high-dose intraarterial cisplatin (150 mg/m2) and sodium thiosulfate. Shrinking "large-field" portals were started on Week 6 and finished on Week 7 with a cumulative dose of 76.8-81.6 Gy. The main outcome measures of the study were the primary and neck response rates, the 2-year and 5-year overall survival and disease-specific survival rates, and acute and late treatment morbidity. RESULTS The median follow-up was 77 months. Complete response rates at the primary and regional lymph nodes were both 88%. The 2-year overall survival and disease-specific survival rates were 57% and 68%, respectively; whereas the 5-year overall survival and disease-specific survival rates were 33% and 42%, respectively. Two patients had Grade 4 mucosal toxicity, and no patient experienced neurologic or significant hematologic toxicities. Within 1 year of treatment, 58% of patients had used a feeding tube. CONCLUSIONS The HYPERRADPLAT regimen produced excellent response rates and overall survival rates comparable to those achieved by patients who had unresectable oropharyngeal carcinomas. Tolerance of the therapy was good, and further studies using HYPERRADPLAT with induction therapy may improve outcomes further in this subset of patients with unfavorable disease.
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Affiliation(s)
- Paul M Spring
- Division of Otolaryngology-Head and Neck Surgery, University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA.
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159
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Salama JK, Vokes EE, Chmura SJ, Milano MT, Kao J, Stenson KM, Witt ME, Haraf DJ. Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2005; 64:382-91. [PMID: 16213104 DOI: 10.1016/j.ijrobp.2005.07.005] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Revised: 06/15/2005] [Accepted: 07/01/2005] [Indexed: 11/15/2022]
Abstract
PURPOSE To define favorable pretreatment characteristics for overall survival (OS), progression-free survival (PFS), locoregional control, and freedom from distant metastasis for patients with recurrent and second primary head-and-neck cancer treated with concomitant chemotherapy and reirradiation. METHODS AND MATERIALS Our study population comprised a subset of 115 previously irradiated patients without overt metastases from 304 poor-prognosis head-and-neck cancer patients treated in seven consecutive phase I-II protocols. Of the 115 patients, 49, who had undergone surgical resection, were treated with a median of four cycles of concurrent chemotherapy and reirradiation and 66, who had not undergone surgical resection, were treated with a median of five cycles. The following regimens were used: 5-fluorouracil and hydroxyurea concurrent with reirradiation (FHX) (n=14), cisplatin plus FHX (n=23), paclitaxel plus FHX (n=42), gemcitabine plus paclitaxel and 5-fluorouracil concurrent with reirradiation (n=26), and irinotecan plus FHX (n=10). RESULTS The median lifetime radiation dose was 131 Gy. The median follow-up for surviving patients was 67.4 months (range, 18.5-158.7). The median OS and PFS was 11 and 7 months (range, 0.2-158.7), respectively. The 3-year OS, PFS, locoregional control, and freedom from distant metastasis rate was 22%, 33%, 51%, and 61%, respectively. Multivariate analysis identified reirradiation dose, triple agent (cisplatin-, paclitaxel-, or gemcitabine-containing chemotherapy), and surgery before protocol treatment as independently prognostic for OS, PFS, and locoregional control. Triple-agent chemotherapy was prognostic for freedom from distant metastasis. Nineteen patients died of treatment-related toxicity, five of these of carotid hemorrhage. CONCLUSION For recurrent and second primary head-and-neck cancer, trimodality therapy with surgery, concurrent chemotherapy, and reirradiation for a full second dose offers potential for long-term survival. Owing to the substantial toxicity and lack of an optimal regimen, reirradiation of recurrent head-and-neck cancer should be limited to clinical trials.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Camptothecin/administration & dosage
- Camptothecin/analogs & derivatives
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Cisplatin/administration & dosage
- Combined Modality Therapy
- Deoxycytidine/administration & dosage
- Deoxycytidine/analogs & derivatives
- Female
- Fluorouracil/administration & dosage
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Humans
- Hydroxyurea/administration & dosage
- Irinotecan
- Male
- Mandibular Diseases/surgery
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/radiotherapy
- Neoplasms, Second Primary/surgery
- Osteoradionecrosis/surgery
- Paclitaxel/administration & dosage
- Prognosis
- Radiotherapy Dosage
- Treatment Failure
- Treatment Outcome
- Gemcitabine
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Affiliation(s)
- Joseph K Salama
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL 60637-1470, USA
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160
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Yom SS, Machtay M, Biel MA, Sinard RJ, El-Naggar AK, Weber RS, Rosenthal DI. Survival Impact of Planned Restaging and Early Surgical Salvage Following Definitive Chemoradiation for Locally Advanced Squamous Cell Carcinomas of the Oropharynx and Hypopharynx. Am J Clin Oncol 2005; 28:385-92. [PMID: 16062081 DOI: 10.1097/01.coc.0000162422.92095.9e] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patients who have received definitive radiation therapy (RT) for a nonlaryngeal T3/4 head and neck squamous cell carcinoma have a limited opportunity for post-RT surgical salvage. The authors reviewed the practice of planned post-RT restaging to determine its impact on the success of early surgical salvage. METHODS A retrospective review was performed for patients with resectable T3/4 cancers of the oropharynx and hypopharynx treated with RT +/- chemotherapy who underwent planned restaging clinically, radiographically (CT or MRI), and by direct laryngoscopy with biopsy at 4 to 8 weeks post-RT. Chemotherapy was given as induction, concurrently, or both. Neck dissection was performed at time of restaging in patients with primary tumor control and initial N2/N3 neck disease or persistent lymphadenopathy. RESULTS A total of 54 patients had a median follow-up of 34.7 months (range, 7.6-97.8 months). Forty-two patients (78.8%) achieved a complete response (CR) at the primary site immediately after RT. Six developed late local failure at 9 to 61 months, of whom 2 were successfully salvaged. The ultimate 2-year local control among patients with initial CR was 94.8%. The 2-year organ preservation, disease-free survival, and overall survival (OS) rates were was 92.5%, 87%, and 90%, respectively. Twelve patients did not achieve initial CR. Two patients with bulky stage IV disease had unresectable cancers. Ten underwent immediate surgical salvage and 7 achieved local control (1 of whom developed distant metastases) whereas 3 had continued local failure. For patients without initial CR, the 2-year ultimate local control rate was 46.7% and OS was 46.8%. For all patients, overall 2-year local control, organ preservation, and OS rates were 85.6%, 75.6%, and 81.8% respectively. The rate of local failure-free organ preservation was 71.5%. CONCLUSION For patients with T3/4 resectable nonlaryngeal head and neck cancers, planned clinical, radiographic, and pathologic restaging at 1 to 2 months after definitive RT provides the opportunity for early surgical salvage in those who fail at the primary site. This practice produces improved overall local control and survival rates compared with the literature reports for delayed attempted salvage with timing based on the findings of routine postradiation clinical surveillance. Future efforts may focus on the improved selection of patients who would be most likely to require early surgical intervention.
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Affiliation(s)
- Sue S Yom
- Department of Radiation Oncology, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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161
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Wei WI, Ferlito A, Rinaldo A, Gourin CG, Lowry J, Ho WK, Leemans CR, Shaha AR, Suárez C, Clayman GL, Robbins KT, Bradley PJ, Silver CE. Management of the N0 neck--reference or preference. Oral Oncol 2005; 42:115-22. [PMID: 15979931 DOI: 10.1016/j.oraloncology.2005.04.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Accepted: 04/11/2005] [Indexed: 10/25/2022]
Abstract
For patients with squamous cell carcinoma of the upper aerodigestive tract, appropriate management of the regional lymph nodes is an important and often controversial issue that has significant influence on survival. Over the years radical treatment either by surgery or radiotherapy contributed to improvement in prognosis. Recently, a more conservative approach has achieved a similar level of cancer control with less morbidity. This review considers the issues of selection of patients for treatment of the neck, choice of modality and extent of therapy, treatment of the contralateral neck, management of recurrence and influence of the site and status of the primary lesion.
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Affiliation(s)
- William I Wei
- Division of Head and Neck Surgery, Otorhinolaryngology, Plastic and Reconstructive Surgery, Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, Peoples Republic of China
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162
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Eckardt A, Barth EL, Kokemueller H, Wegener G. Recurrent carcinoma of the head and neck: treatment strategies and survival analysis in a 20-year period. Oral Oncol 2004; 40:427-32. [PMID: 14969822 DOI: 10.1016/j.oraloncology.2003.09.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Accepted: 09/24/2003] [Indexed: 11/22/2022]
Abstract
Following clinical diagnosis of a recurrent tumor, curative treatment is seldom available. Depending on the size of the recurrent tumor and the patient's general health condition extensive surgical resections and reconstructions are avoided in favor of non-surgical palliative intended treatment modalities. According to the literature location of the tumor, tumor size, as well as R-1- and R-2-resection rates are the most frequent reasons for the development of recurrent tumors. In a retrospective evaluation a population of 1000 patients who were treated for a primary head and neck cancer during the period from 1979 to 1996 were analysed descriptively. Survival probabilities of patients with recurrent tumors were calculated according to the product-limit method by Kaplan-Meier, different treatment concepts were compared and analysed with the log-rank test for significant differences. The largest proportion of primary tumors involved the floor of mouth ( n = 369, 36.9%). A total of 198 patients (19.8%) developed a recurrent cancer; 79.8% of patients experienced a recurrent cancer within two years following primary treatment. Within the group of T1/T2 tumors the incidence of recurrent tumors was 28.9%, whereas the incidence in the T3/T4 group was 44.6%. Tumor infiltration of the resection margins was detected in 12.9%. In line with the literature, tumor infiltration of the resection margins is a relevant prognostic factor, therefore intraoperative frozen section must be recommended. Treatment with curative intention, in particular extensive surgical resections, is seldom possible, and requires always a very intensive discussion with the patient.
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Affiliation(s)
- A Eckardt
- Department of Oral and Maxillofacial Surgery, Hannover Medical University, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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