title: Salvage surgery for local residual or recurrent pharyngeal cancer after radiotherapy or chemoradiotherapy.
abstract: OBJECTIVE
  Local residual or recurrent pharyngeal cancer after definitive radiotherapy (RT) or chemoradiotherapy (CRT) is correlated to poor prognosis. We analyzed the efficacy of salvage surgery for patients with local residual or recurrent pharyngeal cancer after RT or CRT.
  
  
  METHODS
  Retrospective clinical study with chart review.
  
  
  METHODS
  Between 2001 and 2011, we treated 207 patients with resectable pharyngeal cancer, including 98 patients with oropharyngeal cancer (OPC) and 109 patients with hypopharyngeal cancer (HPC) who received definitive RT or CRT. Local residual or recurrence developed in 59 patients (23 with OPC; 36 with HPC), of whom 42 (18 with OPC; 24 with HPC) underwent salvage surgery. These 42 patients were investigated in this study.
  
  
  RESULTS
  The initial treatments were RT; RT with induction chemotherapy (IC); and concurrent CRT in 12, 9, and 21 patients, respectively. The median radiation dose was 70 Gy. The 3-year disease-specific survival rate after salvage surgery was 40% (median, 26 months). The significant prognostic factors were stage IV prior to initial therapy (P = .049), development of concurrent local and regional relapse (P = .02), and OPC (P = .04).
  
  
  CONCLUSIONS
  The efficacy of salvage surgery for local residual or recurrent pharyngeal cancer was limited. Oropharynx origin, stage IV prior to initial therapy, and concurrent regional relapses were significantly poor prognostic factors. Salvage surgery for HPC is worth challenging aggressively. Conversely, the indication of salvage surgery for OPCs should be carefully considered because of its low cure rate.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Omura
authors.forename: Yuki
authors.initials: Y
authors.lastname: Saito
authors.forename: Mizuo
authors.initials: M
authors.lastname: Ando
authors.forename: Kenya
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ebihara
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamasoba
authors.forename: Takahiro
authors.initials: T
authors.lastname: Asakage
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D059248:Chemoradiotherapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018365:Neoplasm, Residual; D010610:Pharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Pharyngeal cancer; definitive radiotherapy or chemoradiotherapy; local residual and recurrence; salvage surgery