Abstract
Objective: Concurrent chemoradiotherapy (CCRT) is one of the recent emerging modalities for advanced squamous cell carcinoma of the head and neck (SCCHN), because of its good efficacy and functional preservation. However, some of the patients treated by CCRT have residual or recurrent tumors in primary sites and/or cervical lymph nodes. In these cases, salvage surgery is considered to be useful for locoregional control and disease-free survival. This study analyzes the usefulness of salvage surgery after CCRT for SCCHN.
Method: The medical records of 111 consecutive patients (stage II: 17%, stage III: 6%, stage IV: 77%) treated with CCRT for SCCHN (hypopharynx: 49, oropharynx: 28, larynx: 17, nasopharynx: 10, others: 7) from 2003 through 2008 were reviewed.
Results: Fifteen patients underwent 22 surgical procedures. The types of procedures performed were as follows: selective neck dissection: 15, total pharyngolaryngectomy: 3, total laryngectomy: 3, oropharyngeal tumor resection: 1. All the 15 patients with salvage surgery had good locoregional control except two cases. Major wound complications (pharyngocutaneous fistula and necrosis of rectus abdominis myocutaneous free flap) occurred in 2 of 15 patients and were successfully managed by re-operations. There were few other minor complications such as wound infection and laryngeal edema.
Conclusion: Salvage surgery can be safely performed and is considered to be useful for locoregional control after intensive CCRT.
