title: Success of salvage treatment: a critical appraisal of salvage rates for different subsites of HNSCC.
abstract: OBJECTIVE
  Despite advances in interdisciplinary treatment protocols, the chance of cure for recurrent head and neck squamous cell carcinoma (HNSCC) following failed primary therapy is poor and often entails a high morbidity. Recurrence rates vary widely in the literature depending on tumor localization, primary tumor stage, and treatment modality, and only a minority of patients can be salvaged.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  This study valuates the outcomes of patients treated for recurrent squamous cell carcinoma of the larynx, pharynx, and oral cavity in the largest tertiary referral center of Switzerland to find predictors for survival in salvage surgery with curative intent.
  
  
  METHODS
  Included were 176 consecutive patients with recurrent disease after primary curative treatment of HNSCC, in locations mentioned previously. Kaplan-Meier survival analyses with log-rank testing were performed depending on T and N stage, gender, treatment, and location of first relapse to evaluate the impact on overall survival, disease specific survival, and recurrence free survival.
  
  
  RESULTS
  Overall successful salvage rates were 49.2% for laryngeal recurrence, 35.1% for oral cavity, 32.7% for oropharyngeal, and a mere 17.4% for hypopharyngeal recurrences. Predictive factors for better outcome were location of recurrence, female gender, lymph node status, and extent of salvage treatment.
  
  
  CONCLUSIONS
  In case of recurrent disease, laryngeal cancers showed the best salvage rates, whereas in hypopharyngeal relapses, very few patients could be successfully salvaged. Patients therefore should be carefully selected and counseled for salvage treatment according to patient motivation, age, type of previous treatment, surgical resectability, and exclusion of distant recurrence.
authors.affiliation: Clinic of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland katjam87@gmx.net.
authors.forename: Katja
authors.initials: K
authors.lastname: Matoscevic
authors.affiliation: Graf Biostatistics, Winterthur, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Graf
authors.affiliation: Clinic of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Pezier
authors.affiliation: Clinic of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Gerhard F
authors.initials: GF
authors.lastname: Huber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002423:Cause of Death; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D010610:Pharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods / Q000401:mortality*; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D013557:Switzerland; D016896:Treatment Outcome
keywords: HNSCC; outcome; salvage rate; squamous cell carcinoma of the head and neck