Salvage surgery after failed primary concomitant chemoradiation.
OBJECTIVE
Primary treatment of many head and neck cancers is shifting to nonsurgical modalities with concomitant chemoradiation becoming increasing prevalent. With this change, surgery is moving to a role as a salvage treatment modality. As a result of this shift, it is important to understand the issues surrounding surgical salvage after chemoradiation.


RESULTS
Studies have consistently found that salvage surgery after chemoradiation carries a high complication rate, higher than either primary surgery or salvage surgery after radiation alone. There are very few reports on the success rate of salvage surgery after failed primary concurrent chemoradiation, but what little data we have seems to suggest success rates approximate success rates for salvage after radiation therapy. There are also reasons to believe that efficacy of salvage surgery varies by stage and site of disease. Also, fundamental differences in the nature of cancer after failed primary therapy have been elucidated by recent studies.


CONCLUSIONS
While salvage surgery is fraught with higher morbidity and lower efficacy than primary surgery, it remains the only potentially curative option available to patients who have failed 'organ preservation' primary therapy. We review issues to consider when managing these challenging patients.
Lee
Steve C
SC
Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, USA. slee@unch.unc.edu
Shores
Carol G
CG
Weissler
Mark C
MC
D003131:Combined Modality Therapy; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications; D016879:Salvage Therapy; D017211:Treatment Failure; D016896:Treatment Outcome