title: The effectiveness of salvage surgery after the failure of primary concomitant chemoradiation in head and neck cancer.
abstract: OBJECTIVE
  To determine survival outcomes and locoregional control rates in patients with locoregional head and neck squamous cell cancer (HNSCC) who failed primary concomitant chemoradiation (CRT) intended for cure and underwent attempted surgical salvage.
  
  
  METHODS
  Design was a nonrandomized retrospective cohort study. Of 204 patients with HNSCC who received primary concomitant chemoradiation intended for cure between 1995 and 2004, 38 recurred and underwent attempted salvage surgery at a tertiary care academic center.
  
  
  RESULTS
  Among the 38 patients undergoing surgical salvage, 12- and 24-month overall survival rates were 60 percent and 27 percent. Locoregional control at 24 months was 42 percent. Lower survival was seen with initial N3 disease (P = 0.0115). Overall surgical morbidity was 24 percent.
  
  
  CONCLUSIONS
  The results of salvage surgery after failed chemoradiation for HNSCC are poor. Those with N3 disease fare least well. Patients should be well informed about the realistic chances of cure and potential morbidity of surgery.
authors.affiliation: General Clinical Research Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7070, USA.
authors.forename: Luke M
authors.initials: LM
authors.lastname: Richey
authors.forename: Carol G
authors.initials: CG
authors.lastname: Shores
authors.forename: Jonathan
authors.initials: J
authors.lastname: George
authors.forename: Steve
authors.initials: S
authors.lastname: Lee
authors.forename: Marion J
authors.initials: MJ
authors.lastname: Couch
authors.forename: David K
authors.initials: DK
authors.lastname: Sutton
authors.forename: Mark C
authors.initials: MC
authors.lastname: Weissler
mesh_terms: D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D017211:Treatment Failure