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Hartl DM, Guerlain J, Gorphe P, Kapre M, Kapre Gupta N, Saba NF, Robbins KT, Ronen O, Rodrigo JP, Strojan P, Mäkitie AA, Kowalski LP, Shah JP, Ferlito A. Review of Outcomes after Salvage Surgery for Recurrent Squamous Cell Carcinoma of the Head and Neck. Cancers (Basel) 2023; 15:4692. [PMID: 37835386 PMCID: PMC10571840 DOI: 10.3390/cancers15194692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Surgery with adjuvant chemoradiotherapy or chemoradiotherapy is the mainstay in treatment for advanced stage head and neck squamous cell carcinoma; however, locoregional recurrences are frequent. Salvage surgery could be proposed in selected patients to improve local control, disease-free, and overall survival. Factors for improved disease-free and overall survival in patients treated with salvage surgery include age, tumor location, the initial T stage, HPV status, resection margins, and the time elapsing from the initial treatment. Clinical trials with adjuvant therapies have shown promise after salvage surgery in terms of tolerance and response, but clinical guidelines for using these adjuvant treatments are currently lacking. The aim of this review is to present current knowledge concerning the incidence and management of recurrent head and neck squamous cell carcinoma and current data concerning survival and morbidity after salvage surgery.
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Affiliation(s)
- Dana M. Hartl
- Department of Anesthesia, Surgery, and Interventional Radiology, Head and Neck Oncology Service, 94805 Villejuif, France
| | - Joanne Guerlain
- Department of Anesthesia, Surgery, and Interventional Radiology, Head and Neck Oncology Service, 94805 Villejuif, France
| | - Philippe Gorphe
- Department of Anesthesia, Surgery, and Interventional Radiology, Head and Neck Oncology Service, 94805 Villejuif, France
| | - Madan Kapre
- Department of ENT and Head Neck Surgery, Neeti Clinics Nagpur, Nagpur 440010, India
| | - Neeti Kapre Gupta
- Department of ENT and Head Neck Surgery, Neeti Clinics Nagpur, Nagpur 440010, India
| | - Nabil F. Saba
- The Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - K. Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, IL 62703, USA
| | - Ohad Ronen
- Department of Otolaryngology—Head and Neck Surgery, Galilee Medical Center Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, IUOPA, ISPA, CIBERONC, 33204 Oviedo, Spain
| | - Primož Strojan
- Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
| | - Luiz P. Kowalski
- Head and Neck Surgery Department, University of São Paulo Medical School, Sao Paulo 05403-000, Brazil
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo 01509-001, Brazil
| | - Jatin P. Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy
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Higher Risk of Recurrence in Patients Treated for Head and Neck Cancer with Low BMI and Elevated Levels of C-Reactive Protein. Cancers (Basel) 2022; 14:cancers14205161. [PMID: 36291945 PMCID: PMC9600233 DOI: 10.3390/cancers14205161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/01/2022] [Accepted: 10/19/2022] [Indexed: 01/08/2023] Open
Abstract
Simple Summary Head and neck cancer (HNC) treatment poses several challenges in clinical practice, and treatment side effects can be debilitating due to the close proximity of important anatomical structures. Cancer recurrence post-treatment presents some of the most challenging HNC management issues. This prospective study identifies high-risk groups for recurrence of head and neck cancer, based on commonly accessible clinical parameters. In this study with 272 HNC patients, elevated pre- and post-treatment CRP levels, low BMI and advanced stage at admission indicate higher risk for recurrence of disease. Using these parameters, a risk model is proposed which may be useful for estimating the probability of cancer recurrence and allow the identification of high and low-risk patients. Abstract This prospective study identifies high-risk groups for recurrence of head and neck cancer by BMI and circulating inflammatory response markers. Head and neck cancer patients from three Swedish hospitals were included (n = 272). Leukocyte and thrombocyte counts, CRP levels, and BMI were measured pre-treatment and post-treatment. Associations between the four factors and treatment failure (residual tumor, loco-regional failure, general failure/distant metastasis) were assessed using a Cox proportional hazards model adjusted for sex, age at the initial visit, smoking status, cancer stage, and hemoglobin count. CRP level was the only significant single variable, with an average increase in risk of recurrence of 74% (p = 0.018) for every doubling. The predictive power of a combined model using all variables was highest during the initial months after treatment, with AUC under the ROC curve 0.75 at the 0–3 month timepoints. Patients with elevated pre- and post-treatment CRP levels are at higher risk for recurrence of disease. Male patients with low post-treatment BMI, advanced stage, and high CRP at any time post treatment are at high risk for recurrence. The combined model may be useful for stratifying post-treatment patients into low and high-risk groups, to enable more detailed follow-up or additional treatment regimens.
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Dassé R, Dupin C, Gorphe P, Temam S, Dupret-Bories A, Vergez S, Dufour X, Aubry K, de Monès E. Proposal for an algorithm to avoid neck dissection during salvage total laryngectomy. A GETTEC multicentric study. Oral Oncol 2022; 133:106026. [PMID: 35914443 DOI: 10.1016/j.oraloncology.2022.106026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To identify the factors related to the presence of occult metastases before salvage total laryngectomy (STL) in rcN0 patients and to propose an algorithm to identify patients who do not require neck dissection (ND). PATIENTS AND METHODS This multicentric retrospective study included five centers with recruitment from 2008 to 2018. Inclusion criteria were: i) having been treated for laryngeal squamous cell carcinoma in first intention by radiotherapy (either alone or potentiated or preceded by induction chemotherapy), ii) having received STL with or without ND, iii) having an rcN0 neck at the time of STL. RESULTS 120 patients met the inclusion criteria. The overall rate of occult metastases was 9.1 %. The rate was significantly higher in patients with an initial positive cN+ lymph node status (p < 0.005) and in advanced stages with rcT3-T4 lesions at recurrence (p < 0.005). Patients with occult metastases recurred earlier than those without (p = 0.002). The overall survival of patients was the same with or without ND (p = 0.16). There were significantly more healing complications requiring revision surgery in the group with ND than in the group without (p = 0.048). CONCLUSION ND does not confer a net survival benefit and is associated with significant complications. Patients without initial lymph node metastases who are rcT1-T2 at recurrence or rcT3-T4 with a recurrence period of more than 12 months could benefit from STL without ND. This decisional algorithm, which needs to be validated, would help avoid 58 % of ND procedures and their proven morbidity. DISCIPLINE Head and neck surgery.
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Affiliation(s)
- Romain Dassé
- Department of Head and Neck Surgery, Bordeaux University Hospital, F33000 Bordeaux, France
| | - Charles Dupin
- Department of Radiation Oncology, Bordeaux University Hospital, F33000 Bordeaux, France.
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
| | - Séphane Temam
- Department of Head and Neck Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
| | - Agnès Dupret-Bories
- Agnès Dupret-Bories, Head and Neck Surgery, University Cancer Institute of Toulouse Oncopole, Claudius Regaud Institute, France.
| | - Sébastien Vergez
- Department of Head and Neck Surgery, University Cancer Institute of Toulouse Oncopole, University Hospital of Toulouse, France.
| | - Xavier Dufour
- Department of Head and Neck Surgery, Poitiers University Hospital, France.
| | - Karine Aubry
- Department of Head and Neck Surgery, Limoges University Hospital, France.
| | - Erwan de Monès
- Department of Head and Neck Surgery, Bordeaux University Hospital, F33000 Bordeaux, France.
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