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Author Notes:

Correspondence: marc.hamoir@uclouvain.be; Tel.: +1-3227641974; Fax: +1-3227648935

This article was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).

All the authors have actively and substantially contributed to the work reported.

Conceptualization, M.H.; Methodology, M.H.; Validation, M.H., S.S., A.F., Writing-Original Draft Preparation, M.H., S.S.; Writing-Review & Editing, C.S., P.S., K.A.H., J.P.R., W.M.M., R.S., N.F.S., A.K.D., M.H.J., C.R.B., E.M.G., A.R., A.F.; Supervision, A.F.

All the authors declare no conflict of interest.

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Research Funding:

This research received no specific funding from funding agencies in the public, commercial and not-profit sectors.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • cancer recurrence
  • head and neck cancer
  • squamous cell carcinoma
  • treatment failure
  • salvage surgery
  • DISEASE-FREE SURVIVAL
  • 2ND PRIMARY HEAD
  • ORAL-CAVITY
  • SURGICAL SALVAGE
  • TOTAL LARYNGECTOMY
  • OROPHARYNGEAL CANCER
  • RADIATION-THERAPY
  • CONCURRENT CHEMORADIOTHERAPY
  • POSTOPERATIVE COMPLICATIONS
  • CONCOMITANT CHEMORADIATION

The Current Role of Salvage Surgery in Recurrent Head and Neck Squamous Cell Carcinoma

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Journal Title:

Cancers

Volume:

Volume 10, Number 8

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Type of Work:

Article | Final Publisher PDF

Abstract:

Chemoradiotherapy has emerged as a gold standard in advanced squamous cell carcinoma of the head and neck (SCCHN). Because 50% of advanced stage patients relapse after nonsurgical primary treatment, the role of salvage surgery (SS) is critical because surgery is generally regarded as the best treatment option in patients with recurrent resectable SCCHN. Surgeons are increasingly confronted with considering operation among patients with significant effects of failed non-surgical primary treatment. Wide local excision to achieve clear margins must be balanced with the morbidity of the procedure, the functional consequences of organ mutilation, and the likelihood of success. Accurate selection of patients suitable for surgery is a major issue. It is essential to establish objective criteria based on functional and oncologic outcomes to select the best candidates for SS. The authors propose first to understand preoperative prognostic factors influencing survival. Predictive modeling based on preoperative information is now available to better select patients having a good chance to be successfully treated with surgery. Patients with a high comorbidity index, advanced oropharyngeal or hypopharyngeal primary tumors, and both local and regional recurrence have a very limited likelihood of success with salvage surgery and should be strongly considered for other treatments. Following SS, identifying patients with postoperative prognostic factors predicting high risk of recurrence is essential because those patients could benefit of adjuvant treatment or be included in clinical trials. Finally, defining HPV tumor status is needed in future studies including recurrent oropharyngeal SCC patients.

Copyright information:

© 2018 by the authors.Licensee MDPI, Basel, Switzerland.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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