Outcome of Salvage Therapy in Isolated Regional Recurrence in Head and Neck Squamous Cell Carcinoma

Roland Giger; Raffael Fink; Marco Demattè; Miranda Visini; Olgun Elicin; Lukas Anschuetz

doi:10.1002/lary.28550

Outcome of Salvage Therapy in Isolated Regional Recurrence in Head and Neck Squamous Cell Carcinoma

Laryngoscope. 2021 Jan;131(1):67-72. doi: 10.1002/lary.28550. Epub 2020 Feb 14.

Authors

Roland Giger¹, Raffael Fink¹, Marco Demattè^{1

2}, Miranda Visini¹, Olgun Elicin³, Lukas Anschuetz¹

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck and Sensory Organs Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
³ Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

PMID: 32057106
DOI: 10.1002/lary.28550

Abstract

Objectives/hypothesis: Head and neck squamous cell carcinoma (HNSCC) has a high tendency for regional lymphatic spreading. Nevertheless, isolated regional lymph node recurrences are rare, and only limited data regarding its management are available. The aim of this study was to describe treatment modalities and outcomes, and to identify prognostic factors. Study Design Retrospective cohort study.

Methods: The records of all patients (n = 498) with tumor persistence or recurrence after curatively intended treatment for HNSCC were retrospectively reviewed. Patients with synchronous secondary tumors at initial presentation, tumor persistence, local or locoregional recurrence, and systemic metastases were excluded.

Results: A total of 76 patients were included. The rate of occult additional metastasis in radiologically uninvolved neck compartments during salvage neck dissection was 25%. The salvaged patients showed a 37.5% 5-year recurrence-free survival (RFS). Multivariate analysis revealed initial stage IVA-B (hazard ratio [HR]: 4.16, P < .01), extracapsular spread (HR: 3.71, P = .04), higher involved/total lymph node ratio (HR: 6.79, P < .01), and soft-tissue infiltration (HR: 3.27, P < .01) as independent adverse prognostic factors for RFS. Moreover, univariate data analysis identified recurrent stage rcN2-3; clinical involvement of the neck levels IV, V and/or VI; and smoking as adverse risk factors for RFS.

Conclusions: This study identifies initial stage IVA-B, extracapsular spread, higher involved/total lymph node ratio, and soft-tissue infiltration as independent adverse prognostic factors for RFS following isolated regional recurrences. The incidence of occult additional metastasis of radiologically uninvolved levels during salvage neck dissections was high (25%). Therefore, superselective or selective neck dissection would not have been the adequate type of salvage surgery.

Level of evidence: 4 Laryngoscope, 131:67-72, 2021.

Keywords: Regional recurrence; head and neck squamous cell carcinoma; outcome; salvage therapy.

MeSH terms

Female
Humans
Male
Middle Aged
Neck Dissection
Neoplasm Metastasis
Neoplasm Recurrence, Local / pathology
Neoplasm Recurrence, Local / therapy*
Prognosis
Retrospective Studies
Salvage Therapy*
Squamous Cell Carcinoma of Head and Neck / therapy*