Survival Impact of Planned Restaging and Early Surgical Salvage Following Definitive Chemoradiation for Locally Advanced Squamous Cell Carcinomas of the Oropharynx and Hypopharynx
- 1 August 2005
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in American Journal of Clinical Oncology
- Vol. 28 (4), 385-392
- https://doi.org/10.1097/01.coc.0000162422.92095.9e
Abstract
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. 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. 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%. 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.Keywords
This publication has 48 references indexed in Scilit:
- Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgeryHead & Neck, 2003
- Outcome of Salvage Total Laryngectomy Following Organ Preservation TherapyJAMA Otolaryngology–Head & Neck Surgery, 2003
- Larynx Preservation in Pyriform Sinus Cancer: Preliminary Results of a European Organization for Research and Treatment of Cancer Phase III TrialJNCI Journal of the National Cancer Institute, 1996
- Primary and salvage surgery for cancer of the tonsillar region: A retrospective study of 120 patientsHead & Neck, 1993
- Induction Chemotherapy plus Radiation Compared with Surgery plus Radiation in Patients with Advanced Laryngeal CancerNew England Journal of Medicine, 1991
- Adjuvant chemotherapy for advanced head and neck squamous carcinomaCancer, 1987
- Cisplatin and Fluorouracil as Neoadjuvant Therapy in Head and Neck Cancer: A Preliminary ReportJAMA Otolaryngology–Head & Neck Surgery, 1987
- A randomized trial of adjuvant chemotherapy in head and neck cancer.Journal of Clinical Oncology, 1985
- Combination Chemotherapy prior to Definitive Local Therapy in Squamous Cell Carcinoma of the Head and NeckOncology, 1985
- Surgical management of postradiation residual/recurrent cancer of the base of the tongueJournal of Surgical Oncology, 1980