title: [Outcomes of salvage laryngectomy after initial radiation failure in laryngeal squamous cell carcinoma].
abstract: OBJECTIVE
  To investigate survival outcomes of salvage surgery preformed for laryngeal squamous cell carcinoma that recurred or progressed after radiotherapy alone.
  
  
  METHODS
  A review of 72 patients who underwent salvage laryngectomy for laryngeal cancer failed in initial radiation therapy between 1996 and 2005 was performed. The tumor persistence occurred in 50 cases and recurrence in 22 cases. All patients received salvage total laryngectomy and radical neck dissection. Survival analysis was performed by using Kaplan-Meier method, Log-rank test and Cox proportional hazard model.
  
  
  RESULTS
  Thirty patients developed a postoperative complication after salvage surgery. Pharyngocutaneous fistula occurred in 15(20.8%) patients. During 5 years after salvage surgery, the rates of tumor recurrence, distant metastasis and second malignancy were 34.7%, 22.2% and 6.9%, respectively. Kaplan-Meier analysis showed that overall 3 year and 5 year survival rates of those patients after operation were 45.8% and 36.1%, respectively. Univariate analysis indicated that N restage, tumor persistence/recurrences after radiotherapy, surgical margin status, level of tumor invasion, pathologic N stage, extracapsular nodal spread and invasion of nonlymphotic structures were significantly associated with overall survival. Multivariate analysis showed the most significant prognostic factors were tumor persistence or recurrence after radiotherapy, surgical margin status and level of tumor invasion.
  
  
  CONCLUSIONS
  Surgical salvage remains the gold standard for management after failure of initial radiation therapy. The extent of tumor invasion must be assessed sufficiently before operation, and the surgical margin status must be identified in operation by using a frozen sectioning approach, especially in patients with tumor invasion to muscle/cartilage and tumor persistence after radiotherapy.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Bethune International Peace Hospital of People's Liberation Army, Shijiazhuang 050082, China.
authors.forename: Bin
authors.initials: B
authors.lastname: DI
authors.forename: Xiao-ming
authors.initials: XM
authors.lastname: Li
authors.forename: Yao-dong
authors.initials: YD
authors.lastname: Shang
authors.forename: Qi
authors.initials: Q
authors.lastname: Song
authors.forename: Zhen-feng
authors.initials: ZF
authors.lastname: Tao
authors.forename: Ji-min
authors.initials: JM
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D017211:Treatment Failure; D055815:Young Adult