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Molteni G, Comini L, Le Pera B, Bassani S, Ghirelli M, Martone A, Mattioli F, Nocini R, Santoro R, Spinelli G, Presutti L, Marchioni D, Mannelli G. Salvage neck dissection for isolated neck recurrences in head and neck tumors: Intra and postoperative complications. J Surg Oncol 2021; 124:740-750. [PMID: 34152604 DOI: 10.1002/jso.26576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/04/2021] [Accepted: 05/27/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The current evidence regarding complications after salvage neck dissection (ND) for isolated regional recurrences (IRRs) in head and neck cancers is poor. The aim of this study is to evaluate the incidence and differences in complication rates of salvage ND after primary surgery, radiotherapy, chemoradiotherapy, or combined treatments. METHODS This was a multicentric retrospective study on 64 patients who underwent salvage ND for IRR in three Italian institutes between 2008 and May 2020. RESULTS Complications were detected in 7 of the 34 patients (20.8%) and surgeons described difficult dissection in 20 patients (58.82%). Accidental vascular ligations or nervous injury during surgery were never detected. None of the variables analyzed were statistically significant in predicting the risk of complications, disease-free survival, or overall survival. CONCLUSIONS IRR represents a rare entity among total relapses. The incidence of complications after salvage ND for IRR is higher than after primary surgery but at an acceptable rate in experienced hands. However, an adequate balance between functional and oncological outcomes is mandatory.
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Affiliation(s)
- Gabriele Molteni
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Lara Comini
- Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Beatrice Le Pera
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Sara Bassani
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Michael Ghirelli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Andrea Martone
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Francesco Mattioli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Riccardo Nocini
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Roberto Santoro
- Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Giuseppe Spinelli
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Livio Presutti
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Giuditta Mannelli
- Head and Neck Oncology and Robotic Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Prognostic capacity of the weighted lymph node ratio in head and neck squamous cell carcinoma patients treated with salvage neck dissection. Eur Arch Otorhinolaryngol 2021; 278:4005-4010. [PMID: 33452917 DOI: 10.1007/s00405-020-06598-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the study was to assess the prognostic capacity of the recently described weighted lymph node ratio (WLNR) in patients with head and neck squamous cell carcinoma (HNSCC) who undergo salvage neck dissection for regional recurrence. MATERIAL AND METHODS We retrospectively studied 197 adult patients with head and neck squamous cell carcinoma treated with salvage neck dissection from 1990 to 2017. RESULTS The mean value for the WLNR for all patients was 26.2%. We established a classification based on the WLNR values taking 10.8% as the cut-off point. Five-year disease-specific survival for patients with WLNR ≤ 10.8% (n = 89, 45.2%) was 39.9% (IC 95% 29.4-50.4%), and for patients with WLNR ≥ 10.8% (n = 108, 54.8%) it was 20.5% (IC 95% 12.3-28.7%) (p = 0.007). The multivariate analysis showed the WLNR had a significant prognostic capacity. CONCLUSIONS As a variable that integrates data related to the number of metastatic nodes with extracapsular spread to the LNR, the WLNR has a prognostic value in the pathological assessment of HNSCC patients with regional recurrence treated with salvage neck dissection.
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Giger R, Fink R, Demattè M, Visini M, Elicin O, Anschuetz L. Outcome of Salvage Therapy in Isolated Regional Recurrence in Head and Neck Squamous Cell Carcinoma. Laryngoscope 2020; 131:67-72. [PMID: 32057106 DOI: 10.1002/lary.28550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/13/2020] [Accepted: 01/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Head and neck squamous cell carcinoma (HNSCC) has a high tendency for regional lymphatic spreading. Nevertheless, isolated regional lymph node recurrences are rare, and only limited data regarding its management are available. The aim of this study was to describe treatment modalities and outcomes, and to identify prognostic factors. Study Design Retrospective cohort study. METHODS The records of all patients (n = 498) with tumor persistence or recurrence after curatively intended treatment for HNSCC were retrospectively reviewed. Patients with synchronous secondary tumors at initial presentation, tumor persistence, local or locoregional recurrence, and systemic metastases were excluded. RESULTS A total of 76 patients were included. The rate of occult additional metastasis in radiologically uninvolved neck compartments during salvage neck dissection was 25%. The salvaged patients showed a 37.5% 5-year recurrence-free survival (RFS). Multivariate analysis revealed initial stage IVA-B (hazard ratio [HR]: 4.16, P < .01), extracapsular spread (HR: 3.71, P = .04), higher involved/total lymph node ratio (HR: 6.79, P < .01), and soft-tissue infiltration (HR: 3.27, P < .01) as independent adverse prognostic factors for RFS. Moreover, univariate data analysis identified recurrent stage rcN2-3; clinical involvement of the neck levels IV, V and/or VI; and smoking as adverse risk factors for RFS. CONCLUSIONS This study identifies initial stage IVA-B, extracapsular spread, higher involved/total lymph node ratio, and soft-tissue infiltration as independent adverse prognostic factors for RFS following isolated regional recurrences. The incidence of occult additional metastasis of radiologically uninvolved levels during salvage neck dissections was high (25%). Therefore, superselective or selective neck dissection would not have been the adequate type of salvage surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 131:67-72, 2021.
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Affiliation(s)
- Roland Giger
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raffael Fink
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Demattè
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck and Sensory Organs Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Miranda Visini
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Zenga J, Gross J, Fowler S, Chen J, Vila P, Richmon JD, Varvares MA, Pipkorn P. Salvage of recurrence after surgery and adjuvant therapy: A systematic review. Am J Otolaryngol 2018; 39:223-227. [PMID: 29398187 DOI: 10.1016/j.amjoto.2018.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the oncologic and functional outcomes of patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma after initial management with surgery and adjuvant therapy. DATA SOURCES Ovid Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, and Clinicaltrials.gov. REVIEW METHODS A structured search was performed of the literature to identify studies that included patients undergoing surgical salvage for local, regional, or locoregional recurrent head and neck squamous cell carcinoma without known distant metastases who had been treated with initial surgery and post-operative adjuvant radio- or chemoradiotherapy. Studies were excluded if they did not report at least 1-year survival estimates, included patients who underwent primary non-surgical management, or included those treated with non-surgical salvage therapies or supportive care alone. RESULTS The search strategy yielded 3746 abstracts. After applying exclusion and inclusion criteria, 126 full-texts were reviewed and six studies were included with a total of 222 patients. All studies were retrospective in design and included diverse disease subsites and stages. Complications and functional outcomes were inconsistently reported. Five-year survival estimates ranged between 10% and 40% between studies. CONCLUSIONS Patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma after initial surgery and adjuvant therapy may have a particularly poor prognosis. Future studies are needed to determine functional and quality of life outcomes in this patient population and to identify specific prognostic factors for re-recurrence and survival.
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Affiliation(s)
- Joseph Zenga
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Otolaryngology, Boston, MA, United States.
| | - Jennifer Gross
- Washington University, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, United States
| | - Susan Fowler
- Washington University, School of Medicine, Saint Louis, MO, United States
| | - Jenny Chen
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Otolaryngology, Boston, MA, United States
| | - Peter Vila
- Washington University, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, United States
| | - Jeremy D Richmon
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Otolaryngology, Boston, MA, United States
| | - Mark A Varvares
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Otolaryngology, Boston, MA, United States
| | - Patrik Pipkorn
- Washington University, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, United States
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León X, Rigó A, Farré N, López M, García J, de Juan J, Quer M. Prognostic significance of extracapsular spread in isolated neck recurrences in head and neck squamous cell carcinoma patients. Eur Arch Otorhinolaryngol 2016; 274:527-533. [DOI: 10.1007/s00405-016-4249-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/05/2016] [Indexed: 11/30/2022]
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Update of assessment of survival in head and neck cancer after regional recurrence. JOURNAL OF ONCOLOGY 2012; 2012:154303. [PMID: 23125856 PMCID: PMC3483779 DOI: 10.1155/2012/154303] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/09/2012] [Accepted: 09/09/2012] [Indexed: 11/18/2022]
Abstract
Objective. To evaluate site of regional recurrence in patients with squamous cell carcinoma of upper aerodigestive tract after neck dissection and the results of salvage treatment. Methods. 95 patients with regional recurrence as the first manifestation of relapse were selected between 943 patients who underwent neck dissection. We evaluated level and side of recurrence, as well disease control after salvage treatment. Results. Level II was the most frequent site of recurrence. Salvage treatment was performed in 51% of ipsilateral and in 75% of contralateral (nondissected neck) recurrences. Control of the disease 12 months after salvage surgery was 25% in the ipsilateral and 37% in contralateral recurrences. Conclusions. Cervical recurrences occur predominantly in level II. Relapse in level I is frequent only in oral cavity tumors and relapse in level V is rare. The neck recurrence carries a poor prognosis even among patients who underwent retreatment with curative intent.
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Rabalais A, Walvekar RR, Johnson JT, Smith KJ. A cost-effectiveness analysis of positron emission tomography-computed tomography surveillance versus up-front neck dissection for management of the neck for N2 disease after chemoradiotherapy. Laryngoscope 2012; 122:311-4. [PMID: 22252963 DOI: 10.1002/lary.22464] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/29/2011] [Accepted: 08/02/2011] [Indexed: 01/14/2023]
Abstract
OBJECTIVES/HYPOTHESIS To study the cost effectiveness of positron emission tomography-computerized tomography (PET-CT) scanning in the management of the neck after chemoradiotherapy (CRT). STUDY DESIGN Cost effectiveness and decision analysis model. METHODS A cost-effectiveness analysis comparing up-front neck dissection to serial PET-CT imaging in a hypothetical clinical scenario of debate. A patient with an oropharygeal cancer with pretreatment N2 disease having a complete response was considered. Standardized costs were obtained using national databases. A literature review in PubMed was performed to obtain information on incidence, probabilities, and range for various clinical events in the algorithm. RESULTS PET-CT strategy costs an average of $14,492 per patient. Neck dissection had a 0.6% greater efficacy in controlling neck disease with a $22,433 incremental cost. CONCLUSIONS Our results strongly support the use of PET-CT imaging as the more cost-effective strategy for surveillance of neck after completion of definitive CRT compared to up-front neck dissection.
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Affiliation(s)
- Amy Rabalais
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA
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Kolokythas A. Long-term surgical complications in the oral cancer patient: a comprehensive review. Part I. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2010; 1:e1. [PMID: 24421971 PMCID: PMC3886056 DOI: 10.5037/jomr.2010.1301] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 06/04/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Oral and oropharyngeal cancer remains among the top ten most common malignancies in the United States and worldwide. Over the last several decades the approach to treatment of oral cancer has changed very little with regards to primary tumour extirpation while the approach to the "at risk" lymph nodes has evolved significantly. Perhaps the most significant change in the surgical treatment of cancer is the introduction of free flap for reconstruction post resection. Despite these surgical advances, oral cancer ablation, still results in the sacrifice of several functional and aesthetic organs. The aim of this article was to provide a comprehensive review of the potential long-term complications associated with surgical treatment of oral cancer and their management. MATERIAL AND METHODS The available English language literature relevant to long-term surgical complications associated with surgical treatment of oral cancer was reviewed. The potential common as well as rarer complications that may be encountered and their treatment are summarized. RESULTS In total 50 literature sources were obtained and reviewed. The topics covered in the first part of this review series include ablative surgery complications, issues with speech, swallowing and chewing and neurologic dysfunction. CONCLUSIONS The early complications associated with oncologic surgery for oral cancer are similar to other surgical procedures. The potential long-term complications however are quite challenging for the oncologic team and the patient who survives oral cancer, primarily due to the highly specialized regional tissues involved in the surgical field.
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Affiliation(s)
- Antonia Kolokythas
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago. Chicago USA
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Implications of head and neck cancer treatment failure in the neck. Otolaryngol Head Neck Surg 2010; 142:722-7. [PMID: 20416463 DOI: 10.1016/j.otohns.2010.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 01/19/2010] [Accepted: 01/20/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Study the survival of patients with cervical lymphatic squamous cell carcinoma recurrence. STUDY DESIGN Review of tumor registry database. SETTING Academic health science center. SUBJECTS AND METHODS Forty-seven isolated neck recurrence patients identified from 224 recurrences from a total of 1291 patients treated between 1998 and 2007. The main outcome measurements were neck lymph nodal recurrence, treatment-specific survival, and overall survival. RESULTS A total of 47 patients had neck recurrence; 10 of the neck recurrence patients (21.3%) had regional disease (N+) at initial presentation. Median survival for patients with neck recurrence was 14.7 months (95% confidence interval [CI] 8.6-18.1 mo), and five-year survival for this group was five percent (95% CI 0%-30%). Neck dissection salvage therapy for neck recurrence resulted in the best survival. CONCLUSION Neck dissection as a salvage therapy for neck recurrence resulted in the best survival, and there was no survival benefit in terms of whether a patient had a neck dissection or not as his or her initial therapy.
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Jeong WJ, Jung YH, Kwon SK, Hah JH, Kwon TK, Sung MW, Kim KH. Role of Surgical Salvage for Regional Recurrence in Laryngeal Cancer. Laryngoscope 2007; 117:74-7. [PMID: 17202934 DOI: 10.1097/01.mlg.0000240184.75588.dc] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to analyze the pattern of regional recurrence in laryngeal cancer, evaluate the role of surgical salvage, and identify factors affecting salvage outcome. METHODS Retrospective analysis was conducted on medical records from a 16-year period. Of 463 patients diagnosed with laryngeal cancer, 25 patients with regional recurrence managed with salvage neck dissection were identified and subject to study. Isolated local recurrences and all distant metastases were excluded. RESULTS All patients were male with a median age of 61 years. The overall rate of regional recurrence was 5.4%. Median time to regional recurrence was 13 months. Isolated regional recurrence occurred in 76% of cases, whereas locoregional recurrence occurred in 24%. A 5-year survival rate for patients undergoing neck dissection as salvage management was 61.2%. Patients with recurrence in the contralateral neck were definitely associated with poor prognosis. Although standard statistical significance was not met, trends for poorer salvage result were identified in patients with a history of local recurrence before regional recurrence, recurrence in a previously dissected neck, and recurred node size of 3 cm or above. CONCLUSIONS Our study shows that salvage neck dissection for regional recurrence in laryngeal cancer is an acceptable approach. Surgical eradication of disease should be warranted whenever possible. Prudent planning of management is mandatory in the presence of history of local recurrence before regional recurrence, previously dissected neck, large size of recurrent node, and contralateral neck recurrence.
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Affiliation(s)
- Woo-Jin Jeong
- Department of Otolaryngology-Head & Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
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Kupferman ME, Morrison WH, Santillan AA, Roberts D, Diaz EM, Garden AS, Weber R. The role of interstitial brachytherapy with salvage surgery for the management of recurrent head and neck cancers. Cancer 2007; 109:2052-7. [PMID: 17407106 DOI: 10.1002/cncr.22648] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The role of interstitial brachytherapy (IBT) in the salvage surgical management of regional lymphatic metastases for head and neck cancer has not been defined to date. To further explore its therapeutic benefit in the management of head and neck squamous cell carcinoma, the authors reviewed their experience utilizing IBT at the M. D. Anderson Cancer Center. METHODS A retrospective chart review of all patients who were received IBT for cervical recurrences of head and neck cancer was undertaken. Twenty-two patients were identified; all patients underwent neck dissection and intraoperative placement of afterloading catheters as part of the salvage treatment. Soft tissue reconstruction was performed when necessary. The duration and dosage of salvage brachytherapy was reviewed, and the overall disease-free survival rates were determined. RESULTS All patients had been treated with external beam radiation therapy prior to recurrence, with an average dose of 65 grays (Gy), and 46% of patients had undergone prior neck dissection. The median time to regional recurrence after definitive treatment was 30 months. Soft tissue coverage of the surgical bed with a muscle flap, most commonly a pectoralis major flap, was performed in 19 of 22 patients. The median IBT dose was 60 Gy over a total duration of 4 days. Postoperative complications were few, and there were no perioperative deaths. Recurrences in the reirradiated necks occurred in 27% of patients. CONCLUSIONS Regional recurrences are common after multimodality treatment for head and neck cancer and are challenging to manage. Although its role has not been defined clearly, salvage neck dissection with IBT is beneficial in the management of recurrent lymphatic metastases of upper aerodigestive tract carcinomas.
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Affiliation(s)
- Michael E Kupferman
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77096, USA.
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Chopra S, Gupta T, Agarwal JP, Budrukkar A, Ghosh-Laskar S, Dinshaw K. Re-irradiation in the management of isolated neck recurrences: Current status and recommendations. Radiother Oncol 2006; 81:1-8. [PMID: 16971009 DOI: 10.1016/j.radonc.2006.08.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Revised: 07/28/2006] [Accepted: 08/21/2006] [Indexed: 11/21/2022]
Abstract
Recent times have witnessed significant improvements in outcome for head and neck squamous cell carcinomas. Nevertheless, the major pattern of failure continues to remain loco-regional. Isolated neck recurrence, although uncommon, occurs in 5-7% of patients after radical treatment. The options for this subgroup are somewhat limited and are often guided by empiricism rather than evidence. This review attempts to systematically analyze the therapeutic options for patients with isolated neck recurrence following radical treatment for the primary and draining cervical lymph nodes, with a special emphasis on re-irradiation. Salvage neck dissection offers the best chance of cure to patients with resectable neck recurrences. The perceived increased risk of complications of re-irradiation following previous curative dose irradiation has precluded optimal evaluation of its potential in this setting. Post-operative adjuvant re-irradiation should be based on histo-pathological findings of the salvage surgery. Re-irradiation with or without chemotherapy may be considered for unresectable neck recurrences. The role of chemotherapy continues to evolve and is presently not optimally defined. There is lack of high-quality evidence pertinent to salvage therapy leading to vast variations in practice. More patients with recurrent disease should be enrolled onto prospective clinical trials with relevant and meaningful endpoints.
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Affiliation(s)
- Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
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Amar A, Rapoport A. Recidivas regionais nos pacientes com carcinoma epidermóide das vias aerodigestivas superiores submetidos à esvaziamento cervical. Rev Col Bras Cir 2003. [DOI: 10.1590/s0100-69912003000200008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a localização das recidivas regionais em pacientes com carcinoma epidermóide de vias aerodigestivas superiores tratados com esvaziamento cervical, bem como os resultados do tratamento de resgate. MÉTODO: Foram avaliados os prontuários de 943 pacientes submetidos a esvaziamento cervical, dos quais foram selecionados 95 com diagnóstico de recidiva regional isolada como primeira manifestação de recorrência da doença. Foi avaliada a localização da recidiva (lado e nível linfático) e o controle da doença após o tratamento de resgate. RESULTADOS: As recidivas ipsilaterais ocorreram no nível II em 57% dos pacientes. O tratamento de resgate foi realizado em 51% das recidivas ipsilaterais e em 75% das recidivas contralaterais. O controle da doença 12 meses após o resgate foi de 31%, sendo 25% nas recidivas ipsilaterais e 37% nas contralaterais. CONCLUSÕES: As recidivas cervicais ocorrem predominantemente no nível II. As recidivas no nível I são freqüentes apenas nos tumores de boca e as recidivas no nível V são raras. A recidiva cervical tem prognóstico reservado mesmo entre os pacientes submetidos à retratamento com intenção curativa.
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Wenig BL. New therapies for locoregionally advanced and locoregionally recurrent head and neck cancer. Cancer Treat Res 2003; 114:315-30. [PMID: 12619548 DOI: 10.1007/0-306-48060-3_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Barry L Wenig
- Feinberg School of Medicine, Northwestern University, USA
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16
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León X, Gañán L, Costey M, Kolanczak K, Orús C, Quer M. Recidivas ganglionares aisladas en pacientes con carcinomas de cabeza y cuello. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2003; 54:710-7. [PMID: 15164711 DOI: 10.1016/s0001-6519(03)78471-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Recurrencies of lymphatic metastasis implies a poor prognosis in patients with head and neck carcinoma. The aim of our study is to analyse the results of salvage treatment after an isolated regional tumour recurrence. MATERIAL AND METHODS Retrospective study of 144 patients with head and neck carcinoma with an isolated neck recurrence. The treatments used, regional control and patient's survival were analysed. RESULTS Sixty-four percent (92/144) of patients were not candidates to salvage treatment with radical intention. Salvage surgery was performed in 36% (52/144) of patients, with a survival of 46% in this group of patients. Previous treatment of the neck was the most relevant variable to decide a salvage surgery. Patients treated initially with neck dissection had the worst prognosis. CONCLUSIONS The existence of a regional recurrence has a bad prognosis, with 16% 5-year survival. Only 36% of patients were considered candidates to salvage treatment, achieving 46% of survival.
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Affiliation(s)
- X León
- Servicio de Otorrinolaringología, Hospital de Sant Pau., Avda. San Antoni Ma Claret, 167, 08025 Barcelona.
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Neely JG, Hartman JM, Wallace MS, Forsen JW. Tutorials in Clinical Research: Part III. Selecting a Research Approach to Best Answer a Clinical Question. Laryngoscope 2001; 111:821-31. [PMID: 11368073 DOI: 10.1097/00005537-200105000-00013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This is the third in a series of sequential "Tutorials in Clinical Research." The objectives of this specific report are to enable the reader to rapidly dissect a clinical question or article to efficiently determine what critical mass of information is required to answer the question and what study design is likely to produce the answer. STUDY DESIGN Tutorial. METHODS The authors met weekly for 3 months exploring clinical problems and systematically recording the logic and procedural pathways from multiple clinical questions to the selection of proper research approaches. The basic elements required to understand the processes of selection were catalogued and field tested, and a report was produced to define and explain these elements. RESULTS Fundamental to a research approach is the assembly of subjects and the allocation of exposures. An algorithm leading to the selection of an approach is presented. The report is organized into three parts. The tables serve as a rapid reference section. The initial two-part narrative explains the process of approach selection. The examples section illustrates the application of the selection algorithm. CONCLUSIONS Selecting the proper research approach has six steps: the question, logic and ethics,identification of variables, data display considerations, original data source considerations, and selection of prototypical approaches for assembly of subjects. Field tests of this approach consistently demonstrated its utility.
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Affiliation(s)
- J G Neely
- Clinical Research Working Group, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Box 8115, St. Louis,MO 63110, USA
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