title: Salvage Resection for Isolated Local and/or Regional Failure of Head/Neck Cancer Following Definitive Concurrent Chemoradiotherapy Case Series and Review of the Literature.
abstract: BACKGROUND
  Primary management of advanced head/neck cancers involves concurrent chemoradiotherapy . Subsequently, regional and local failures are managed with resection but there have been few reports that describe the morbidity and disease control outcomes of surgical salvage in this setting.
  
  
  METHODS
  Retrospective analysis describes complications, survival, and patterns of failure after salvage resection of isolated local and/or regional failures of head/neck cancer following definitive concurrent chemoradiotherapy.
  
  
  RESULTS
  Sixteen patients were identified for inclusion: laryngectomy in 11 patients, oral cavity/oropharynx resection in 2 patients, and neck dissection alone in 4 patients. Ten patients required graft tissue reconstruction (6 pedicle and 4 free flap). Median post-operative hospitalization was 7 days (range 3-19), and 4 patients required hospital re-admission. At a median survivor follow-up of 15.8 months (range 4.3-34.9), 10 patients were alive (6 without evidence of disease). Seven patients experienced disease recurrence at a median 6.7 months (range 0-12.6) following salvage resection (2 with isolated distant failures). Estimated 2-year local/regional control, freedom from failure, and overall survival were 58%, 39%, and 58%, respectively.
  
  
  CONCLUSIONS
  Surgical salvage after primary definitive concurrent chemoradiotherapy is feasible with toxicity and outcomes similar to prior radiotherapy alone or sequential chemotherapy and radiation. Local andregional recurrence remains the predominant pattern of failure.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Kearney
authors.forename: John M
authors.initials: JM
authors.lastname: Watkins
authors.forename: Keisuke
authors.initials: K
authors.lastname: Shirai
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wahlquist
authors.forename: John A
authors.initials: JA
authors.lastname: Fortney
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Garrett-Mayer
authors.forename: M Boyd
authors.initials: MB
authors.lastname: Gillespie
authors.forename: Anand K
authors.initials: AK
authors.lastname: Sharma