Surgical management of recurrent tumor in the neck

Prognostic significance of late cervical metastasis and distant failure in patients with stage I and II oral tongue cancers

Stage I and II oral tongue cancers (OTC) generally have a favorable prognosis, but there are some early OTC cases with a poor prognosis. OTC is known for its propensity for subclinical nodal metastasis and, moreover, we must devise a strategy that takes account of the possibility of recurrence and distant metastasis. In the current study, 90 previously untreated patients with stage I or II OTC who underwent surgical treatment were eligible for review. The authors investigated the associations of their clinico-pathologic factors with disease outcomes, and also examined the postoperative course for patients with a poor prognosis. The most common cause of death was distant metastasis and late cervical lymph node metastasis (LCM) was the significantly independent prognostic variable. Since LCM can be treated with salvage surgery, the central issue is to control patients with distant metastises who are free of disease in their loco-regional sites.

[Recurrent tumors in the oral and maxillofacial region. Results and treatment strategies in 20 years]

SUBJECT MATTER: 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 nonsurgical treatment modalities with palliative intent. According to the literature, location of the tumor, tumor size and R-1 and R-2 resection rates are the most frequent reasons for the development of recurrent tumors.

PATIENTS AND METHODS

In a retrospective evaluation, a population of 1000 patients who had been treated for primary head and neck cancer during the period from 1979 to 1996 were analyzed descriptively. Survival probabilities of patients with recurrent tumors were calculated according to the Kaplan-Meier product-limit method, and different treatment concepts were compared and analyzed with the log-rank test for significant differences.

RESULTS

The largest proportion of primary tumors involved the floor of the mouth (n=369, 36.9%). A total of 198 patients (19.8%) developed recurrent cancer; 79.8% of patients experienced recurrent cancer within 2 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%.

CONCLUSIONS

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 always requires a very intensive discussion with the patient.

Recidivas ganglionares aisladas en pacientes con carcinomas de cabeza y cuello

OBJECTIVE

Recurrencies of lymphatic metastasis implies a poor prognosis in patients with head and neck carcinoma. The aim of our study is to analyse the results of salvage treatment after an isolated regional tumour recurrence.

MATERIAL AND METHODS

Retrospective study of 144 patients with head and neck carcinoma with an isolated neck recurrence. The treatments used, regional control and patient's survival were analysed.

RESULTS

Sixty-four percent (92/144) of patients were not candidates to salvage treatment with radical intention. Salvage surgery was performed in 36% (52/144) of patients, with a survival of 46% in this group of patients. Previous treatment of the neck was the most relevant variable to decide a salvage surgery. Patients treated initially with neck dissection had the worst prognosis.

CONCLUSIONS

The existence of a regional recurrence has a bad prognosis, with 16% 5-year survival. Only 36% of patients were considered candidates to salvage treatment, achieving 46% of survival.