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Predictors of survival in patients undergoing oropharyngeal surgery for cancer recurrence after radiation therapy

  • Head and Neck
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Abstract

Purpose

The incidence of oropharyngeal squamous cell carcinoma continues to rise with the majority of patients receiving definitive or adjunctive radiation. For patients with locoregional recurrence after radiation, optimal treatment involves salvage surgery. The aim of this study is to identify factors that predict survival to ultimately improve patient selection for salvage surgery.

Methods

Retrospective cohort study at an NCI-designated cancer center. We analyzed patients with a history of head and neck radiation who presented with persistent/recurrent or second primary disease requiring salvage oropharyngeal resection from 1998–2017 (n = 120). Patients were stratified into three classes based on time to recurrence and presence of laryngopharyngeal dysfunction. Primary outcomes were 5-year overall survival (OS) and disease specific survival (DSS).

Results

Median OS was 27 months (median follow-up 20 months). Five-year OS was 47% for class I (recurrence > 2 years), 26% for class II (recurrence ≤ 2 years), and 0% for class III (recurrence ≤ 2 years and laryngopharyngeal dysfunction), (p < 0.0001). Five-year DSS showed significant differences between classes (p < 0.0001). On multivariate analysis, class remained predictive of OS (p = 0.04– < 0.001) and DSS (p = 0.04–0.001). Adjuvant radiation after salvage surgery with negative margins showed superior OS (71% vs. 28%, p = 0.01) and DSS (83% vs 37%, p = 0.02) compared to surgery alone and was a significant predictor of improved survival on multivariate analysis (HR 0.1, p = 0.04).

Conclusion

This study identified a subset of patients with oropharyngeal cancer recurrence within two years of initial treatment and with laryngopharyngeal dysfunction who have poor outcomes for salvage surgery.

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Acknowledgements

MEH was supported by the National Institutes of Health (T32 DC005356). JCB was supported in part by the American Cancer Society (132034-RSG-18-062-01-TBG). SBC was supported by the National Institutes of Health/National Cancer Institute (K08CA226350-02).

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Author notes

  1. Andrew J. Rosko and Matthew E. Spector have contributed equally.

Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109-5312, USA

    Molly E. Heft Neal, Julia Brennan, Catherine T. Haring, J. Chad Brenner, Keith A. Casper, Kelly M. Malloy, Chaz L. Stucken, Scott A. McLean, Mark E. Prince, Carol R. Bradford, Gregory T. Wolf, Andrew G. Shuman, Steven B. Chinn, Andrew J. Rosko & Matthew E. Spector

  2. Department of Internal Medicine, Medical Oncology, University of Michigan, Ann Arbor, MI, USA

    Francis Worden & Paul Swiecicki

  3. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA

    Michelle Mierzwa

  4. Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada

    Douglas B. Chepeha

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  1. Molly E. Heft Neal
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Contributions

Conceptualization: MES, AJR, MEHN; methodology: MES, AJR and MEHN; data acquisition: MEHN, JB, FW, PS, MM, KAC, KMM, CLS, SAM, MEP, CRB, GTW, AGS, SBC, DBC, AJR, and MES; supervision: MES, AJR; formal analysis and investigation: MES, AJR, and MEHN; writing—original draft preparation: MEHN; writing—review and editing: MEHN, JB, CTH, JCB, FW, PS, MM, KAC, KMM, CLS, SAM, MEP, CRB, GTW, AGS, SBC, DBC, AJR, and MES; supervision: MES, AJR.

Corresponding author

Correspondence to Molly E. Heft Neal.

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Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, University of Michigan Institutional Review Board (HUM00081554), and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Supplementary file1 (DOCX 14 kb)

405_2020_5913_MOESM2_ESM.pdf

Supplemental fig. 1: Five-year Overall Survival (OS) and disease specific survival (DSS) stratified by A) primary neck dissection, B) recurrent nodal status, C) tobacco use, D) BMI, and E) use of radiation after salvage surgery with negative margins (PDF 83 kb)

405_2020_5913_MOESM3_ESM.pdf

Supplemental fig. 2: five-year overall survival (OS) and disease specific survival (DSS) stratified by HPV status (PDF 66 kb)

Supplemental fig. 3: five-year overall survival (OS) stratified by primary tumor location (PDF 43 kb)

Supplemental fig. 4: locoregional (LR) control rates by use of adjuvant radiation (PDF 45 kb)

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Heft Neal, M.E., Brennan, J., Haring, C.T. et al. Predictors of survival in patients undergoing oropharyngeal surgery for cancer recurrence after radiation therapy. Eur Arch Otorhinolaryngol 277, 2085–2093 (2020). https://doi.org/10.1007/s00405-020-05913-z

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