John M. Watkins MD, Presenter: Nothing to Disclose

John Arthur Fortney MD, Abstract Co-Author: Nothing to Disclose

Keisuke S Shirai MD, Abstract Co-Author: Nothing to Disclose

Amy Wahlquist MS, Abstract Co-Author: Nothing to Disclose

Elizabeth Garrett-Mayer PhD, Abstract Co-Author: Nothing to Disclose

M. Boyd Gillespie MD, Abstract Co-Author: Nothing to Disclose

Terry L. Day, Abstract Co-Author: Nothing to Disclose

Anand K Sharma MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Describe survival outcomes and patterns of failure of surgical salvage for isolated local and/or regional recurrence in a cohort of HNC patients treated with definitive concurrent CRT.

Single institution retrospective involving review of departmental records and quality assurance database. Eligible cases included HNC patients treated with salvage resection following local and/or regional failure after definitive platinum-based CRT. Surgical salvage was defined as curative-intent resection for residual disease following CRT or subsequent development of recurrent primary and/or nodal disease and/or in-field second primary tumor. Post-salvage survival and patterns of failure were recorded.

Between September 2001 and October 2007, 136 patients initiated CRT for loco-regionally advanced HNC. At a median survivor follow-up of 33.1 months (range 4.6-71.1), isolated head/neck recurrence developed as the initial site of failure in 28 patients (20.6%). Seventeen patients underwent salvage surgery, involving laryngectomy (n=11), oral cavity/oropharynx composite resection (2), or neck dissection alone (4), with flap reconstruction in 10 patients. Excluding one patient with no evidence of disease at laryngectomy, median post-operative hospitalization was 7 days (range 3-19), with significant complications of hematoma (n=4), wound breakdown (3), and fistula (1). One patient required immediate post-salvage chemotherapy and one chemoradiotherapy for adverse pathologic features. At a median survivor follow-up of 15.8 months (range 4.3-34.9) post-salvage, 10 patients are alive (6 without evidence of disease). Recurrence developed in 7 patients at a median 6.7 months post-salvage (range 0-12.6), involving 1 resected primary site, 2 dissected necks, 1 resected primary and dissected neck, 2 distant failures, and 1 progression of an unresectable primary. All but one patient had stage III-IV recurrence. Crude 2-year freedom from failure and overall survival was 36% and 50%, respectively.  

Salvage resection of local and/or regional HNC failures following CRT is feasible and can provide the opportunity for durable disease control and survival.

Few data have evaluated the efficacy, survival, and failure patterns of salvage resection following modern concurrent chemoradiotherapy for recurrent head/neck cancer.

Watkins, J, Fortney, J, Shirai, K, Wahlquist, A, Garrett-Mayer, E, Gillespie, M, Day, T, Sharma, A, et al, , Survival and Patterns of Failure of Salvage Resection for Isolated Local and/or Regional Failure of Head/Neck Cancer (HNC) Following Definitive Concurrent Chemoradiotherapy (CRT).  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6008419.html