Salvage surgery after failure of very accelerated radiotherapy in advanced head-and-neck squamous cell carcinoma.
OBJECTIVE
To assess the efficacy and toxicity of salvage surgery for local or cervical nodal recurrence after accelerated radiotherapy for locally advanced head-and-neck squamous cell carcinoma (HNSCC).


METHODS
We reviewed the medical records of the 136 patients with HNSCC who had been treated in three consecutive clinical trials at the Institut Gustave-Roussy using a very accelerated radiotherapy regimen (62 to 64 Gy with 2 daily fractions of 1.8 to 2 Gy over 3.5 weeks). Sixty-nine patients of the 136 initial patients (51%) had local or neck lymph nodes relapse, or both.


RESULTS
Sixteen of these 69 patients (23%) had undergone salvage surgery for recurrence locally (n = 8) or in the cervical nodes (n = 8). All 16 had initially been diagnosed with locally advanced oropharyngeal carcinoma (T4, 11 patients; T3, 5 patients), and 13 had initially had cervical node involvement. After salvage surgery, 6 patients had had a local recurrence; 7, cervical node recurrence; and 3, distant metastasis. Thus, salvage surgery had been successful only in 3 patients. The 3- and 5-year overall actuarial survival rates were 20% and 11%, respectively. Eight patients had major postoperative wound complications, including carotid rupture in three cases.


CONCLUSIONS
Salvage surgery for relapse after very accelerated radiotherapy for advanced HNSCC is infrequently feasible and is of limited survival benefit. It should be used only in carefully selected cases.
Department of Otorhinolaryngology-Head and Neck Surgery, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
Stephane
S
Temam
Erwin
E
Pape
François
F
Janot
Pierre
P
Wibault
Morbize
M
Julieron
Antoine
A
Lusinchi
Gérard
G
Mamelle
Patrick
P
Marandas
Bernard
B
Luboinski
Jean
J
Bourhis
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D011879:Radiotherapy Dosage; D016879:Salvage Therapy / Q000401:mortality; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome