title: Salvage surgery after concomitant chemoradiation in head and neck squamous cell carcinomas - stratification for postsalvage survival.
abstract: BACKGROUND
  Salvage surgery after concomitant chemoradiation therapy (CCRT) for patients with head and neck squamous cell carcinomas (HNSCC) is challenging because of its associated morbidity/mortality and the poor prognoses of these patients.
  
  
  METHODS
  The outcome analysis of prospectively collected data from 93 patients with HNSCC with local and/or regional shows treatment failures but without distant metastasis after CCRT.
  
  
  RESULTS
  Thirty-eight patients underwent salvage surgery, whereas 55 underwent palliative treatment, with 2-year overall survival rates of 43.4% and 0%, respectively. Initial stage IV tumors (p = .017) and concurrent local and regional failures (p = .003) were independent predictors for decreased survival after salvage surgery. Two-year overall survival rates for patients with 2, 1, or none of these predictive factors were 0%, 49%, and 83%, respectively (p = .0005).
  
  
  CONCLUSIONS
  Salvage surgery after CCRT has acceptable outcomes. Initial stage IV tumors and concurrent local and regional failures were independent predictors that can stratify patients into distinct prognostic groups for postsalvage survival.
authors.affiliation: Department of Head and Neck Surgery, Institut de Cancérologie Gustave Roussy, Villejuif, France.
authors.forename: Hiang Khoon
authors.initials: HK
authors.lastname: Tan
authors.forename: Roland
authors.initials: R
authors.lastname: Giger
authors.forename: Anne
authors.initials: A
authors.lastname: Auperin
authors.forename: Jean
authors.initials: J
authors.lastname: Bourhis
authors.forename: François
authors.initials: F
authors.lastname: Janot
authors.forename: Stephane
authors.initials: S
authors.lastname: Temam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures; D010166:Palliative Care; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy; D015996:Survival Rate; D017211:Treatment Failure