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Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation

  • Joris B. W. Elbers
  • Lars I. Veldhuis
  • Patrick A. Bhairosing
  • Ludi E. Smeele
  • Katarzyna Jóźwiak
  • Michiel W. M. van den Brekel
  • Marcel Verheij
  • Abrahim Al-Mamgani
  • Charlotte L. ZuurEmail author
Review Article
  • 97 Downloads

Abstract

Purpose

Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma (HNSCC) is known to result in poor prognosis. As there are only small and heterogeneous studies available with wide variety in outcome measures, our purpose was to select and pool literature according to specific criteria.

Methods

Systematic review and meta-analysis of clinical outcome after salvage surgery for recurrent advanced stage HNSCC following primary radiotherapy or chemoradiation.

Results

16 of 3956 screened studies were included for analysis (729 patients). Pooled 5-year OS was 37% (95% CI 30–45%, 12 studies, 17 outcome measurements, 540 patients). Outcome was presented for larynx (6 studies, 397 patients), hypopharynx (2 studies, 47 patients), larynx and hypopharynx combined (3 studies, 69 patients) or separately (1 study, 134 patients), oral cavity (1 study, 11 patients), oropharynx (1 study, 34 patients) and multiple subsites combined (2 studies, 37 patients). There was no significant difference in survival outcome between subsites (pheterogeneity = 0.8116). The pooled tumor-positive resection margin rate was 32% and pooled re-operation rate 17%. Complication rates from the pooled data were: fistulas 33%, wound infections 24% and flap failure 3%. Treatment-related mortality rate was 1% and mean hospital stay was 23 days.

Conclusions

Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma after primary (chemo)radiotherapy is a good last resort curative treatment option, resulting in 37% overall survival at 5 years. As data from advanced stage non-laryngeal tumors were sparse, no solid conclusions can be drawn with regard to outcome differences between tumor subsites.

Keywords

Head and neck squamous cell carcinoma Radiotherapy Salvage surgery Advanced stage 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no competing interest.

Ethical standards

The present study is a systematic review of literature and in that sense did not involve human participants. However, all procedures we performed were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study does not fall under the scope of the Medical Research Involving Human Subjects Act (WMO), which means that no informed consent had to be obtained.

Supplementary material

405_2019_5292_MOESM1_ESM.tiff (8.3 mb)
Supplementary material 1 (TIFF 8492 KB)
405_2019_5292_MOESM2_ESM.docx (21 kb)
Supplementary material 2 (DOCX 21 KB)

References

  1. 1.
    Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65(1):5–29.  https://doi.org/10.3322/caac.21254 Google Scholar
  2. 2.
    Gatta G, Botta L, Sanchez MJ, Anderson LA, Pierannunzio D, Licitra L, Group EW (2015) Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: the EUROCARE-5 population-based study. Eur J Cancer.  https://doi.org/10.1016/j.ejca.2015.07.043 Google Scholar
  3. 3.
    Global Burden of Disease Cancer C, Fitzmaurice C, Allen C et al (2017) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol 3 (4):524–548.  https://doi.org/10.1001/jamaoncol.2016.5688 Google Scholar
  4. 4.
    Hilly O, Gil Z, Goldhaber D, Amit M, Biadsee A, Popovtzer A, Shvero J, Cohen J, Fliss D, Feinmesser R, Bachar G (2015) Elective neck dissection during salvage total laryngectomy—a beneficial prognostic effect in locally advanced recurrent tumours. Clin Otolaryngol 40(1):9–15Google Scholar
  5. 5.
    Leon X, Aguero A, Lopez M, Garcia J, Farre N, Lopez-Pousa A, Quer M (2015) Salvage surgery after local recurrence in patients with head and neck carcinoma treated with chemoradiotherapy or bioradiotherapy. Auris Nasus Larynx 42(2):145–149.  https://doi.org/10.1016/j.anl.2014.10.002 Google Scholar
  6. 6.
    Sanabria A, Kowalski LP, Shaha AR, Silver CE, Werner JA, Mandapathil M, Takes RP, Strojan P, Rinaldo A, Ferlito A (2014) Salvage surgery for head and neck cancer: a plea for better definitions. Eur Arch Otorhinolaryngol 271(6):1347–1350.  https://doi.org/10.1007/s00405-014-2924-7 Google Scholar
  7. 7.
    Ho AS, Kraus DH, Ganly I, Lee NY, Shah JP, Morris LG (2014) Decision making in the management of recurrent head and neck cancer. Head neck 36(1):144–151.  https://doi.org/10.1002/hed.23227 Google Scholar
  8. 8.
    Ramakrishnan Y, Drinnan M, Kwong FN, Grant DG, Mehanna H, Jones T, Paleri V (2014) Oncologic outcomes of transoral laser microsurgery for radiorecurrent laryngeal carcinoma: a systematic review and meta-analysis of English-language literature. Head neck 36(2):280–285.  https://doi.org/10.1002/hed.23291 Google Scholar
  9. 9.
    Paleri V, Thomas L, Basavaiah N, Drinnan M, Mehanna H, Jones T (2011) Oncologic outcomes of open conservation laryngectomy for radiorecurrent laryngeal carcinoma: a systematic review and meta-analysis of English-language literature. Cancer 117(12):2668–2676.  https://doi.org/10.1002/cncr.25831 Google Scholar
  10. 10.
    Holsinger FC, Funk E, Roberts DB, Dias EM Jr (2006) Conservation laryngeal surgery versus total laryngectomy for radiation failure in laryngeal cancer. Head Neck 28(9):779–784Google Scholar
  11. 11.
    Ganly I, Patel SG, Matsuo J, Singh B, Kraus DH, Boyle JO, Wong RJ, Shaha AR, Lee N, Shah JP (2006) Results of surgical salvage after failure of definitive radiation therapy for early-stage squamous cell carcinoma of the glottic larynx. Arch Otolaryngol Head Neck Surg 132(1):59–66Google Scholar
  12. 12.
    Cancer IUA (2010) TNM classification of malignant tumours. Blackwell Publishing Ltd, New YorkGoogle Scholar
  13. 13.
    McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. J Clin Epidemiol 75:40–6Google Scholar
  14. 14.
    Wells GS, O’Connell B, Peterson D, Welch J, Losos V, Tugwell MP (2008) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 22 Jan 2019
  15. 15.
    Koss SL, Russell MD, Leem TH, Schiff BA, Smith RV (2014) Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage. Laryngoscope 124(2):421–428Google Scholar
  16. 16.
    Patel SN, Cohen MA, Givi B, Dixon BJ, Gilbert RW, Gullane PJ, Brown DH, Irish JC, de Almeida JR, Higgins KM, Enepekides D, Huang SH, Waldron J, O’Sullivan B, Xu W, Su S, Goldstein DP (2016) Salvage surgery for locally recurrent oropharyngeal cancer. Head neck 38(Suppl 1):E658–E664.  https://doi.org/10.1002/hed.24065 Google Scholar
  17. 17.
    Li M, Lorenz RR, Khan MJ, Burkey BB, Adelstein DJ, Greskovich JF Jr, Koyfman SA, Scharpf J (2013) Salvage laryngectomy in patients with recurrent laryngeal cancer in the setting of nonoperative treatment failure. Otolaryngol Head Neck Surg 149(2):245–251.  https://doi.org/10.1177/0194599813486257 Google Scholar
  18. 18.
    Andrews G, Lango M, Cohen R, Feigenberg S, Burtness B, Mehra R, Ahmed S, Nicolaou N, Gaughan J, Ridge JA (2011) Nonsurgical management of oropharyngeal, laryngeal, and hypopharyngeal cancer: the Fox Chase Cancer Center experience. Head Neck 33(10):1433–1440Google Scholar
  19. 19.
    Yuen AP, Wei WI, Ho CM (1995) Results of surgical salvage for radiation failures of laryngeal carcinoma. Otolaryngol Head Neck Surg 112(3):405–409Google Scholar
  20. 20.
    Weber RS, Berkey BA, Forastiere A, Cooper J, Maor M, Goepfert H, Morrison W, Glisson B, Trotti A, Ridge JA, Chao KS, Peters G, Lee DJ, Leaf A, Ensley J (2003) Outcome of salvage total laryngectomy following organ preservation therapy: the radiation therapy oncology group trial 91-11. Arch Otolaryngol Head Neck Surg 129(1):44–49Google Scholar
  21. 21.
    Chen WF, Chang KP, Chen CH, Shyu VB, Kao HK (2013) Outcomes of anterolateral thigh flap reconstruction for salvage laryngopharyngectomy for hypopharyngeal cancer after concurrent chemoradiotherapy. PloS One 8(1):e53985.  https://doi.org/10.1371/journal.pone.0053985 Google Scholar
  22. 22.
    Kadota H, Fukushima J, Nakashima T, Kumamoto Y, Yoshida S, Yasumatsu R, Shiratsuchi H, Morita M, Komume S (2010) Comparison of salvage and planned pharyngolaryngectomy with jejunal transfer for hypopharyngeal carcinoma after chemoradiotherapy. Laryngoscope 120(6):1103–1108.  https://doi.org/10.1002/lary.20887 Google Scholar
  23. 23.
    Relic A, Scheich M, Stapf J, Voelter C, Hoppe F, Hagen R, Pfreundner L (2009) Salvage surgery after induction chemotherapy with paclitaxel/cisplatin and primary radiotherapy for advanced laryngeal and hypopharyngeal carcinomas. Eur Arch Otorhinolaryngol 266(11):1799–1805Google Scholar
  24. 24.
    Alcock CJ, Fowler JF, Haybittle JL, Hopewell JW, Rezvani M, Wiernik G (1992) Salvage surgery following irradiation with different fractionation regimes in the treatment of carcinoma of the laryngo pharynx: experience gained from a British Institute of Radiology Study. J Laryngol Otol 106(2):147–153Google Scholar
  25. 25.
    Klozar J, Cada Z, Koslabova E (2012) Complications of total laryngectomy in the era of chemoradiation. Eur Arch Otorhinolaryngol 269(1):289–293.  https://doi.org/10.1007/s00405-011-1598-7 Google Scholar
  26. 26.
    Stankovic M, Milisavljevic D, Zivic M, Stojanov D, Stankovic P (2015) Primary and salvage total laryngectomy. Influential factors, complications, and survival. J Buon 20(2):527–539Google Scholar
  27. 27.
    Wulff NB, Andersen E, Kristensen CA, Sorensen CH, Charabi B, Homoe P (2017) Prognostic factors for survival after salvage total laryngectomy following radiotherapy or chemoradiation failure: a 10-year retrospective longitudinal study in eastern Denmark. Clin Otolaryngol 42(2):336–346.  https://doi.org/10.1111/coa.12726 Google Scholar
  28. 28.
    Yuen AP, Wei WI, Lam LK, Ho WK, Kwong D (1997) Results of surgical salvage of locoregional recurrence of carcinoma of the tongue after radiotherapy failure. Ann Otol Rhinol Laryngol 106(9):779–782Google Scholar
  29. 29.
    Davidson J, Keane T, Brown D, Freeman J, Gullane P, Irish J, Rotstein L, Pintilie M, Cummings B (1997) Surgical salvage after radiotherapy for advanced laryngopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 123(4):420–424Google Scholar
  30. 30.
    Goodwin WJ Jr (2000) Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means? Laryngoscope 110(3 Pt 2 Suppl 93):1–18.  https://doi.org/10.1097/00005537-200003001-00001 Google Scholar
  31. 31.
    Clark JR, De Almeida J, Gilbert R, Irish J, Brown D, Neligan P, Gullane PJ (2006) Primary and salvage (hypo)pharyngectomy: analysis and outcome. Head Neck 28(8):671–677Google Scholar
  32. 32.
    Woodard TD, Oplatek A, Petruzzelli GJ (2007) Life after total laryngectomy: a measure of long-term survival, function, and quality of life. Arch Otolaryngol Head Neck Surg 133(6):526–532.  https://doi.org/10.1001/archotol.133.6.526 Google Scholar
  33. 33.
    Varghese BT, Sebastian P, Mathew A (2009) Treatment outcome in patients undergoing surgery for carcinoma larynx and hypopharynx: a follow-up study. Acta Otolaryngol 129(12):1480–1485.  https://doi.org/10.3109/00016480902748520 Google Scholar
  34. 34.
    Stoeckli SJ, Pawlik AB, Lipp M, Huber A, Schmid S (2000) Salvage surgery after failure of nonsurgical therapy for carcinoma of the larynx and hypopharynx. Arch Otolaryngol Head Neck Surg 126(12):1473–1477Google Scholar
  35. 35.
    Fowler BZ, Muller S, Chen AY, Johnstone PA (2006) Factors influencing long-term survival following salvage total laryngectomy after initial radiotherapy or conservative surgery. Head Neck 28(2):99–106.  https://doi.org/10.1002/hed.20297 Google Scholar
  36. 36.
    Zafereo ME, Hanasono MM, Rosenthal DI, Sturgis EM, Lewin JS, Roberts DB, Weber RS (2009) The role of salvage surgery in patients with recurrent squamous cell carcinoma of the oropharynx. Cancer 115(24):5723–5733.  https://doi.org/10.1002/cncr.24595 Google Scholar
  37. 37.
    Gehanno P, Depondt J, Guedon C, Kebaili C, Koka V (1993) Primary and salvage surgery for cancer of the tonsillar region: a retrospective study of 120 patients. Head Neck 15(3):185–189Google Scholar
  38. 38.
    Timmermans AJ, Lansaat L, Theunissen EA, Hamming-Vrieze O, Hilgers FJ, van den Brekel MW (2014) Predictive factors for pharyngocutaneous fistulization after total laryngectomy. Ann Otol Rhinol Laryngol 123(3):153–161.  https://doi.org/10.1177/0003489414522972 Google Scholar
  39. 39.
    Ganly I, Patel S, Matsuo J, Singh B, Kraus D, Boyle J, Wong R, Lee N, Pfister DG, Shaha A, Shah J (2005) Postoperative complications of salvage total laryngectomy. Cancer 103(10):2073–2081.  https://doi.org/10.1002/cncr.20974 Google Scholar
  40. 40.
    Lee SC, Shores CG, Weissler MC (2008) Salvage surgery after failed primary concomitant chemoradiation. Curr Opin Otol Head Neck Surg 16(2):135–140Google Scholar
  41. 41.
    Agra IM, Carvalho AL, Ulbrich FS, de Campos OD, Martins EP, Magrin J, Kowalski LP (2006) Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer. Head Neck 28(2):107–113.  https://doi.org/10.1002/hed.20309 Google Scholar
  42. 42.
    Kostrzewa JP, Lancaster WP, Iseli TA, Desmond RA, Carroll WR, Rosenthal EL (2010) Outcomes of salvage surgery with free flap reconstruction for recurrent oral and oropharyngeal cancer. Laryngoscope 120(2):267–272.  https://doi.org/10.1002/lary.20743 Google Scholar
  43. 43.
    Tan HK, Giger R, Auperin A, Bourhis J, Janot F, Temam S (2010) Salvage surgery after concomitant chemoradiation in head and neck squamous cell carcinomas—stratification for postsalvage survival. Head Neck 32(2):139–147.  https://doi.org/10.1002/hed.21159 Google Scholar
  44. 44.
    Schwartz GJ, Mehta RH, Wenig BL, Shaligram C, Portugal LG (2000) Salvage treatment for recurrent squamous cell carcinoma of the oral cavity. Head Neck 22(1):34–41Google Scholar
  45. 45.
    Zbaren P, Nuyens M, Curschmann J, Stauffer E (2007) Histologic characteristics and tumor spread of recurrent glottic carcinoma: analysis on whole-organ sections and comparison with tumor spread of primary glottic carcinomas. Head Neck 29(1):26–32.  https://doi.org/10.1002/hed.20502 Google Scholar
  46. 46.
    Jones AS, Bin Hanafi Z, Nadapalan V, Roland NJ, Kinsella A, Helliwell TR (1996) Do positive resection margins after ablative surgery for head and neck cancer adversely affect prognosis? A study of 352 patients with recurrent carcinoma following radiotherapy treated by salvage surgery. Br J Cancer 74(1):128–132Google Scholar
  47. 47.
    Fakhry N, Chamorey E, Michel J, Collet C, Santini L, Poissonnet G, Santini J, Dessi P, Giovanni A, Dassonville O, Bozec A (2013) Salvage circular laryngopharyngectomy and radial forearm free flap for recurrent hypopharyngeal cancer. Laryngoscope 123(4):910–915.  https://doi.org/10.1002/lary.23781 Google Scholar
  48. 48.
    van der Putten L, de Bree R, Kuik DJ, Rietveld DH, Buter J, Eerenstein SE, Leemans CR (2011) Salvage laryngectomy: oncological and functional outcome. Oral Oncol 47(4):296–301.  https://doi.org/10.1016/j.oraloncology.2011.02.002 Google Scholar
  49. 49.
    Hoebers F, Heemsbergen W, Moor S, Lopez M, Klop M, Tesselaar M, Rasch C (2011) Reirradiation for head-and-neck cancer: delicate balance between effectiveness and toxicity. Int J Radiat Oncol Biol Phys 81(3):e111–e118.  https://doi.org/10.1016/j.ijrobp.2011.01.004 Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Joris B. W. Elbers
    • 1
    • 2
  • Lars I. Veldhuis
    • 2
  • Patrick A. Bhairosing
    • 3
  • Ludi E. Smeele
    • 2
    • 4
  • Katarzyna Jóźwiak
    • 5
  • Michiel W. M. van den Brekel
    • 2
    • 4
  • Marcel Verheij
    • 1
  • Abrahim Al-Mamgani
    • 1
  • Charlotte L. Zuur
    • 2
    • 4
    Email author
  1. 1.Department of Radiation OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  2. 2.Department of Head and Neck Surgery and OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  3. 3.Scientific Information ServiceThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  4. 4.Department of Oral-Maxillofacial SurgeryAMCAmsterdamThe Netherlands
  5. 5.Department of Epidemiology and BiostatisticsThe Netherlands Cancer InstituteAmsterdamThe Netherlands

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