Joris B W Elbers1,2, Lars I Veldhuis2, Patrick A Bhairosing3, Ludi E Smeele2,4, Katarzyna Jóźwiak5, Michiel W M van den Brekel2,4, Marcel Verheij1, Abrahim Al-Mamgani1, Charlotte L Zuur6,7. 1. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 2. Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. 3. Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 4. Department of Oral-Maxillofacial Surgery, AMC, Amsterdam, The Netherlands. 5. Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 6. Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. c.zuur@nki.nl. 7. Department of Oral-Maxillofacial Surgery, AMC, Amsterdam, The Netherlands. c.zuur@nki.nl.
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.
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.
Entities:
Keywords:
Advanced stage; Head and neck squamous cell carcinoma; Radiotherapy; Salvage surgery
Authors: Mischa de Ridder; Pieter D de Veij Mestdagh; Joris B W Elbers; Arash Navran; Charlotte L Zuur; Ludi E Smeele; Abrahim Al-Mamgani Journal: Eur Arch Otorhinolaryngol Date: 2019-10-10 Impact factor: 2.503
Authors: Teresa Bernadette Steinbichler; L Golm; D Dejaco; D Riedl; B Kofler; C Url; D Wolfram; H Riechelmann Journal: Eur Arch Otorhinolaryngol Date: 2020-01-25 Impact factor: 2.503
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