Year: 2018
Type: article
Abstract: Chemoradiotherapy has emerged as a gold standard in advanced squamous cell carcinoma of the head and neck (SCCHN). Because 50% of advanced stage patients relapse after nonsurgical primary treatment, the role of salvage surgery (SS) is critical because surgery is generally regarded as the best treatment option in patients with recurrent resectable SCCHN. Surgeons are increasingly confronted with considering operation among patients with significant effects of failed non-surgical primary treatment. Wide local excision to achieve clear margins must be balanced with the morbidity of the procedure, the functional consequences of organ mutilation, and the likelihood of success. Accurate selection of patients suitable for surgery is a major issue. It is essential to establish objective criteria based on functional and oncologic outcomes to select the best candidates for SS. The authors propose first to understand preoperative prognostic factors influencing survival. Predictive modeling based on preoperative information is now available to better select patients having a good chance to be successfully treated with surgery. Patients with a high comorbidity index, advanced oropharyngeal or hypopharyngeal primary tumors, and both local and regional recurrence have a very limited likelihood of success with salvage surgery and should be strongly considered for other treatments. Following SS, identifying patients with postoperative prognostic factors predicting high risk of recurrence is essential because those patients could benefit of adjuvant treatment or be included in clinical trials. Finally, defining HPV tumor status is needed in future studies including recurrent oropharyngeal SCC patients.
Source: Cancers
Institutions: Cliniques Universitaires Saint-Luc, UCLouvain, Universidad de Oviedo, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Cáncer, Instituto de Investigación Sanitaria del Principado de Asturias, Institute of Oncology Ljubljana, The University of Texas MD Anderson Cancer Center, Hospital Universitario Central de Asturias, University of Florida, National Health Service, Guy's Hospital, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Emory University, Winship Cancer Institute, Tata Memorial Hospital, Morristown Medical Center, Atlantic Health System, University of Michigan, Michigan Medicine, Mount Sinai Health System, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, University of Udine
Language: English
Topic: Head and Neck Cancer Studies
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,499
OpenAlex ID: W2885704063