The current role of salvage surgery in recurrent head and neck squamous cell carcinoma

Marc Hamoir, Sandra Schmitz, Carlos Suarez, Primoz Strojan, Kate A. Hutcheson, Juan P. Rodrigo, William M. Mendenhall, Ricard Simo, Nabil F. Saba, Anil K. D‘Cruz, Missak Haigentz, Carol R. Bradford, Eric M. Genden, Alessandra Rinaldo, Alfio Ferlito

Research output: Contribution to journalReview article

6 Citations (Scopus)

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.

Original languageEnglish (US)
Article number267
JournalCancers
Volume10
Issue number8
DOIs
StatePublished - Aug 10 2018

Fingerprint

Recurrence
Salvage Therapy
Carcinoma, squamous cell of head and neck
Chemoradiotherapy
Therapeutics
Patient Selection
Comorbidity
Neoplasms
Clinical Trials
Morbidity
Survival
Surgeons

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Hamoir, M., Schmitz, S., Suarez, C., Strojan, P., Hutcheson, K. A., Rodrigo, J. P., ... Ferlito, A. (2018). The current role of salvage surgery in recurrent head and neck squamous cell carcinoma. Cancers, 10(8), [267]. https://doi.org/10.3390/cancers10080267
Hamoir, Marc ; Schmitz, Sandra ; Suarez, Carlos ; Strojan, Primoz ; Hutcheson, Kate A. ; Rodrigo, Juan P. ; Mendenhall, William M. ; Simo, Ricard ; Saba, Nabil F. ; D‘Cruz, Anil K. ; Haigentz, Missak ; Bradford, Carol R. ; Genden, Eric M. ; Rinaldo, Alessandra ; Ferlito, Alfio. / The current role of salvage surgery in recurrent head and neck squamous cell carcinoma. In: Cancers. 2018 ; Vol. 10, No. 8.
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title = "The current role of salvage surgery in recurrent head and neck squamous cell carcinoma",
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.",
author = "Marc Hamoir and Sandra Schmitz and Carlos Suarez and Primoz Strojan and Hutcheson, {Kate A.} and Rodrigo, {Juan P.} and Mendenhall, {William M.} and Ricard Simo and Saba, {Nabil F.} and D‘Cruz, {Anil K.} and Missak Haigentz and Bradford, {Carol R.} and Genden, {Eric M.} and Alessandra Rinaldo and Alfio Ferlito",
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Hamoir, M, Schmitz, S, Suarez, C, Strojan, P, Hutcheson, KA, Rodrigo, JP, Mendenhall, WM, Simo, R, Saba, NF, D‘Cruz, AK, Haigentz, M, Bradford, CR, Genden, EM, Rinaldo, A & Ferlito, A 2018, 'The current role of salvage surgery in recurrent head and neck squamous cell carcinoma', Cancers, vol. 10, no. 8, 267. https://doi.org/10.3390/cancers10080267

The current role of salvage surgery in recurrent head and neck squamous cell carcinoma. / Hamoir, Marc; Schmitz, Sandra; Suarez, Carlos; Strojan, Primoz; Hutcheson, Kate A.; Rodrigo, Juan P.; Mendenhall, William M.; Simo, Ricard; Saba, Nabil F.; D‘Cruz, Anil K.; Haigentz, Missak; Bradford, Carol R.; Genden, Eric M.; Rinaldo, Alessandra; Ferlito, Alfio.

In: Cancers, Vol. 10, No. 8, 267, 10.08.2018.

Research output: Contribution to journalReview article

TY - JOUR

T1 - The current role of salvage surgery in recurrent head and neck squamous cell carcinoma

AU - Hamoir, Marc

AU - Schmitz, Sandra

AU - Suarez, Carlos

AU - Strojan, Primoz

AU - Hutcheson, Kate A.

AU - Rodrigo, Juan P.

AU - Mendenhall, William M.

AU - Simo, Ricard

AU - Saba, Nabil F.

AU - D‘Cruz, Anil K.

AU - Haigentz, Missak

AU - Bradford, Carol R.

AU - Genden, Eric M.

AU - Rinaldo, Alessandra

AU - Ferlito, Alfio

PY - 2018/8/10

Y1 - 2018/8/10

N2 - 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.

AB - 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.

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U2 - 10.3390/cancers10080267

DO - 10.3390/cancers10080267

M3 - Review article

VL - 10

JO - Cancers

JF - Cancers

SN - 2072-6694

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ER -

Hamoir M, Schmitz S, Suarez C, Strojan P, Hutcheson KA, Rodrigo JP et al. The current role of salvage surgery in recurrent head and neck squamous cell carcinoma. Cancers. 2018 Aug 10;10(8). 267. https://doi.org/10.3390/cancers10080267