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Cancers 2018, 10(8), 267; https://doi.org/10.3390/cancers10080267

The Current Role of Salvage Surgery in Recurrent Head and Neck Squamous Cell Carcinoma

1
Department of Head and Neck Surgery, King Albert II Cancer Institute, St Luc University Hospital, 1200 Brussels, Belgium
2
Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, 1200 Brussels, Belgium
3
Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, 33011 Oviedo, Spain
4
Department of Radiation Oncology, Institute of Oncology, Ljubljana SI-1000, Slovenia
5
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77006, USA
6
Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, CIBERONC, 33011 Oviedo, Spain
7
Department of Radiation Oncology, University of Florida, Gainesville, FL 32610-0385, USA
8
Head and Neck Cancer Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London SE1 9RT, UK
9
Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA 30305, USA
10
Head Neck Services, Tata Memorial Hospital, Parel Mumbai 400012, India
11
Division of Hematology/Oncology, Department of Medicine, Morristown Medical Center/Atlantic Health System, Morristown, NJ 07960, USA
12
Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
13
Department of Otolaryngology—Head and Neck Surgery, Mount Sinai Medical Center, New York, NY 10029, USA
14
University of Udine School of Medicine, 33100 Udine, Italy
15
International Head and Neck Scientific Group, 35030 Padua, Italy
*
Author to whom correspondence should be addressed.
Received: 2 July 2018 / Revised: 6 August 2018 / Accepted: 7 August 2018 / Published: 10 August 2018
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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. View Full-Text
Keywords: cancer recurrence; head and neck cancer; squamous cell carcinoma; treatment failure; salvage surgery cancer recurrence; head and neck cancer; squamous cell carcinoma; treatment failure; salvage surgery
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Hamoir, M.; Schmitz, S.; Suarez, C.; Strojan, P.; Hutcheson, K.A.; Rodrigo, J.P.; Mendenhall, W.M.; Simo, R.; Saba, N.F.; D‘Cruz, A.K.; Haigentz, M., Jr.; Bradford, C.R.; Genden, E.M.; Rinaldo, A.; Ferlito, A. The Current Role of Salvage Surgery in Recurrent Head and Neck Squamous Cell Carcinoma. Cancers 2018, 10, 267.

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