title: Decision making in the management of recurrent head and neck cancer.
abstract: Despite substantial improvements in head and neck squamous cell carcinoma (HNSCC) treatment, the major obstacle to long-term survival remains disease recurrence. Salvage options are often limited due to prior therapy and the escalated morbidity of retreatment. The costs of treatment must be measured against the anticipated quality and quantity of life recovered, even with resectable disease. This review surveys the recurrent HNSCC literature to better guide decision making. Across multiple studies, negative prognostic factors include impaired performance status, advanced recurrent stage, brief disease-free interval, previous chemotherapy, and nonlaryngeal sites of recurrence. When possible, surgical salvage remains the principal option for durable disease control, quality of life preservation, and cure. Nonsurgical therapies have also demonstrated measurable improvements in locoregional control. Interpretation of salvage literature must be tempered by recognition of significant selection bias. The decision for salvage therapy must be individualized, with management that involves well-informed patients resulting in the best outcomes.
authors.affiliation: Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Allen S
authors.initials: AS
authors.lastname: Ho
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Kraus
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.forename: Luc G T
authors.initials: LG
authors.lastname: Morris
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D003657:Decision Making; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D011788:Quality of Life; D019233:Retreatment; D016879:Salvage Therapy / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis
keywords: cancer recurrence; head and neck cancer; quality of life; reirradiation; salvage surgery