title: The role of salvage surgery in patients with recurrent squamous cell carcinoma of the oropharynx.
abstract: BACKGROUND
  The objective of this study was to comprehensively review overall survival, functional outcomes, and prognostic factors in patients who underwent salvage surgery for locally recurrent squamous cell carcinoma of the oropharynx (SCCOP) after initial radiotherapy.
  
  
  METHODS
  The authors retrospectively reviewed 1681 consecutive patients who completed definitive therapy for primary SCCOP and identified 168 patients with locally recurrent SCCOP who underwent salvage surgery (41 patients), reirradiation or brachytherapy (18 patients), palliative chemotherapy (70 patients), or supportive care (39 patients).
  
  
  RESULTS
  Twenty-six of 39 patients (67%) developed a second recurrence after salvage surgery. The 3-year overall survival rate for patients who underwent salvage surgery or received reirradiation, palliative chemotherapy, or supportive care were 48.7%, 31.6%, 3.7%, and 5.1%, respectively. For patients who underwent salvage surgery, older age (P=.03), the absence of a disease-free interval (P<.01), and advanced recurrent tumor stage (P=.07) were associated with lower overall survival. Patients with recurrent neck disease (P=.01) and positive surgical margins (P=.04) had higher rates of recurrence after salvage surgery. Postoperative complications occurred in 19 patients (46%), and there were no perioperative deaths. Functionally, 71% of patients demonstrated>or=80% speech intelligibility, 68% were able to tolerate some oral intake, and 87% who required a tracheotomy subsequently were decannulated.
  
  
  CONCLUSIONS
  Age, disease-free interval, recurrent tumor stage, recurrent neck disease, and surgical margin status influenced overall survival or recurrence rate after salvage surgery for recurrent SCCOP. Although most patients had good functional outcomes, only a select group of patients with recurrent SCCOP achieved long-term survival after salvage surgery.
authors.affiliation: Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas 77230-1402, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Zafereo
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
authors.forename: Jan S
authors.initials: JS
authors.lastname: Lewin
authors.forename: Diana B
authors.initials: DB
authors.lastname: Roberts
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011379:Prognosis; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome