title: Impact of Flap Reconstruction on Radiotoxicity After Salvage Surgery and Reirradiation for Recurrent Head and Neck Cancer.
abstract: Recurrent head and neck malignancies remain a therapeutic challenge. Tissue transfer, in addition to defect coverage and prevention of wound complications, may potentially decrease radiotoxicity. We evaluated radiation toxicity and survival outcomes of patients who underwent salvage surgery with reirradiation, comparing primary closure to flap reconstruction.
  
  
  
  Retrospective outcomes analysis of recurrent head and neck squamous cell carcinoma (HNSCC) patients treated with curative intent by salvage surgery (± flap reconstruction) and reirradiation from 1996 to 2011. Recurrent stage, reirradiation modality, chemotherapy use, and toxicities were evaluated.
  
  
  
  Of 96 patients, 59 had primary closure, whereas 37 underwent flap reconstruction (26 free, 11 pedicled). Median radiation and reirradiation doses were 66 Gy and 60 Gy, respectively. Comparing nonflap and flap patients, there was no significant difference in acute mild toxicities (100 vs. 100 %, p = 1.0) or acute severe toxicities (33.9 vs. 37.8 %, p = 0.83). Nonflap patients experienced significantly greater incidence of both late mild toxicities (81.4 vs. 54.1 %, p = 0.006) and late severe toxicities (47.5 vs. 21.6 %, p = 0.02). Overall survival at 5 years was equivalent (33.1 vs. 34.7 %, p = 0.88). Free flap patients had greater delays to postoperative reirradiation and treatment package times compared with pedicled flap patients but no meaningful difference in survival outcomes.
  
  
  
  Vascularized tissue potentially helps offset late toxicities associated with a second radiation course in recurrent head and neck cancer patients. In these selected patients, flap coverage may confer functional benefits and improve the long-term radiotoxicity profile.
authors: Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Allen S
authors: AS
authors: Ho
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Zachary S
authors: ZS
authors: Zumsteg
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Annika
authors: A
authors: Meyer
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Nadeem
authors: N
authors: Riaz
authors: Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Rahmatullah
authors: R
authors: Rahmati
authors: Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Dennis H
authors: DH
authors: Kraus
authors: Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Colleen
authors: C
authors: McCarthy
authors: Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Richard J
authors: RJ
authors: Wong
authors: Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Jatin P
authors: JP
authors: Shah
authors: Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. leen2@mskcc.org.|Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. leen2@mskcc.org.
authors: Nancy Y
authors: NY
authors: Lee
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D005260:Female; D005402:Fistula / Q000209:etiology*; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D010025:Osteoradionecrosis / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D019233:Retreatment; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology; D015996:Survival Rate; D058106:Wound Closure Techniques / Q000009:adverse effects