Salvage Surgery with Intraoperative Electron Radiation Therapy for Recurrent or Persistent Head and Neck Cancer After Prior Radiotherapy
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background/Objectives: Locoregionally recurrent or persistent head and neck cancer (rpHNC) after prior radiotherapy carries a poor prognosis, and optimal salvage strategies remain uncertain. We evaluated survival, patterns of failure, and 90-day postoperative complications after salvage surgery combined with intraoperative electron radiation therapy (IOERT). Methods: We retrospectively identified 127 previously irradiated patients treated with salvage surgery and IOERT between 1999 and 2023. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method, and locoregional failure (LRF) and distant failure were estimated using Aalen–Johansen cumulative incidence with death as a competing event. Associations were evaluated one predictor at a time in age- and sex-adjusted Cox (OS, DFS) and Fine-Gray (LRF) models without multiplicity adjustment, and they are exploratory. Results: With a median follow-up of 70 months, median overall survival (OS) was 20.5 months (95% CI, 14.6–40.2), with 1-, 2-, and 3-year OS rates of 63%, 48%, and 43%, respectively. Median disease-free survival (DFS) was 8.8 months. Positive surgical margins and extranodal extension (ENE) were associated with worse OS in separate age- and sex-adjusted models. The 1-, 2-, and 3-year cumulative incidences of LRF were 34.3%, 44.7%, and 49.8%, respectively. The corresponding cumulative incidences of distant failure were 21.6%, 24.0%, and 26.7%, respectively. Thirty-seven patients had a documented distant failure, of whom 27 (73%) experienced distant failure within one year. Available records documented three deaths within 90 days (3/127, 2.4%). Conclusions: Among rpHNC patients treated with this IOERT-containing multimodality salvage strategy, median OS was 20.5 months. Because the study lacked a salvage-surgery-only comparator, postoperative treatments were selectively administered, and complication reporting was incomplete, neither the efficacy nor the comparative safety of IOERT can be determined from these data.
Source: Cancers
Authors: Ahmed N. Elguindy, Sujith Baliga, Brett G. Klamer, Allison Palmiero, Khaled N. Dibs, Andrew Koempel, Emile Gogineni, David Konieczkowski, Darrion L. Mitchell, Nolan Seim, Kyle VanKoevering, Catherine Haring, Lauren Miller, Stephen Y. Kang, Amit Agrawal, Enver Ozer, James W. Rocco, Ricardo L. Carrau, Matthew Old, Marcelo Bonomi, Priyanka Bhateja, Arnab Chakravarti, John Grecula, Dukagjin M. Blakaj
Institutions: Ain Shams University, The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, The Ohio State University, Emory University, Winship Cancer Institute, University of Washington, University of Prishtina
Language: English
Topic: Head and Neck Cancer Studies
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,499
Funder: Ohio State University
OpenAlex ID: W7223153899