A total of 215 oral cancer patients were treated from January 2001 to April 2009 at our department. Twenty-one (9.8%) patients were treated by concurrent chemoradiotherapy (CCRT) while 194 patients were treated primarily by surgical resection with or without chemoradiotherapy (surgical group). Within the CCRT group, 5 patients (23.8%, salvage group) underwent surgical resection and reconstruction with free flap due to recurrence of the primary tumor. Seven patients of the surgical group who had already undergone pre-and post-operative chemoradiotherapy underwent secondary reconstruction with free flap (secondary reconstruction group). In this report, local and general complications and the success rate of free flap transfer, etc. are compared and discussed between the salvage group and the secondary reconstruction group. The outcomes of the salvage group were that all patients survived and that one patient was re-operated due to local recurrence. Surgical complications were seen in 4 patients (80%). In this group, two patients (40%) had poor results. In our department, surgical reconstruction with free flap transfer is usually the primary choice after surgical resection with chemoradiotherapy. The surgical problems encountered with this approach are the selection of micro-vessels of the neck region and the irradiation dosage.

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The purpose of this study was to evaluate the results of salvage surgery after concurrent chemoradiotherapy for patients with advanced oral and oropharyngeal cancer. Seventeen patients who received a total dose of more than 60 Gy radiotherapy with concurrent chemotherapy were enrolled in this study. Fourteen out of the 17 patients were given selective intra-arterial chemotherapy and 3 had systemic chemotherapy. Salvage operation by primary tumor resection and neck resection with reconstruction was performed in 8 patients and without reconstruction in 1 patient. Four patients had resection of the primary tumor alone and the remaining 4 had merely neck dissection. The overall postoperative complication rate was 29% but increased to 50% in cases with reconstruction. The five-year survival rate was 56.9%. The outcome of salvage surgery was acceptable but in cases where reconstruction was conducted, repeated operations were required for closure of the oro-cutaneous fistula.

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The aim of this study was to evaluate retrospectively the outcomes of patients with recurrent oral and maxillofacial cancer (OMFC) primarily treated with concurrent intra-arterial chemoradiotherapy (CCRT-HFT) and to identify the prognostic factors.
A total of 51 patients with OMFC who received definitive CCRT-HFT were included.
Of the 51 patients, 88% revealed a clinical complete response, though local recurrence occurred in 16 of 51 patients.
Of 16 patients who received salvage surgery, 6 had a local resection and 10 had a wide resection.
Successful salvage was achieved locally in 11 (69%) of the 16 patients. Survival analysis was performed using the Kaplan-Meier method and the 2-, 3- and 5-year overall survival rates were 58%, 51% and 38%, respectively.
Patients with OMFC who received reconstruction surgery using free flap following a radical resection with (42 cases) and without (105 cases) preoperative CCRT were compared.
The operation time, hemorrhage volume, complications, and rate of successful free flap were not different between the two groups.
Pathologically confirmed lymph node metastasis was the most important prognostic factor for survival.
The number of lymph node metastases and the level of metastasis were important.
Salvage surgery for patients with advanced cancer should be encouraged for selected patients. Further research is essential in order to gain the benefits of definitive CCRT.

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Intra-arterial chemoradiotherapy using superficial temporal and occipital arteries demonstrates good local control and overall survival rates due to the advantage of simultaneous infusion of the anticancer agent with synergistic effects of chemotherapy and radiotherapy. However, local and regional recurrence after the treatment remains a common cause of failure in oral cancer therapy, thus salvage treatment is necessary. We evaluate the prognosis and postoperative complications of salvage surgery after intra-arterial chemoradiotherapy for advanced oral cancer patients.
Between August 2006 and July 2009, a total of 304 patients with carcinoma of the head and neck were referred to the Department of Oral and Maxillofacial Surgery of the Yokohama City University Graduate School of Medicine, and 193 patients were treated in our institute. Among them, 102 patients (52.8%) with carcinoma of the oral cavity and no evidence of distant metastasis underwent intra-arterial chemotherapy via superficial temporal and occipital arteries combined with daily concurrent radiotherapy. Treatment consisted of superselective intra-arterial infusions (docetaxel, total 60 mg/m², cisplatin, total 150 mg/m²) and daily concurrent radiotherapy (total 60 Gy) for 6 weeks. Four weeks after the completion of all treatments, the patients underwent biopsy of the primary lesion and other examinations such as MRI, CT, and ultrasound. Pathological complete response (pCR) of the primary site was achieved in 90 (88.2%) of the 102 patients. Residual disease at the primary site was seen in 12 patients (11.8%), and 4 patients (3.9%) showed local and neck recurrence after the treatment. Salvage surgery was performed in 10 cases (62.5%) among the patients with residual tumor and recurrence (16 cases), of which 5 had postoperative complications. Local recurrence occurred in 4 patients after salvage surgery. Six patients were alive without diseases.

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At our institute, between 1990 and 2008, lateral retropharyngeal node (LRPN) metastasis was found in two patients with squamous cell carcinoma of the buccal mucosa. Primary tumors had invaded from the posterior part of the buccal mucosa. On sectional images, metastatic nodes, measuring 17 × 12 mm and 15 × 12 mm in size, were detected in the retropharyngeal space on the affected side. This study analyzed these two cases plus other four cases with buccal mucosa cancers developing LRPN metastasis reported in Japanese articles and/or proceedings, with an emphasis on the causal lymphatic pathways and clinical characteristics. Carcinoma of the posterior part of the buccal mucosa and/or retromolar trigone may easily invade the buccinator muscle and pterygomandibular raphe to which the buccinator muscle and superior constrictor muscle attach. Moreover, the pterygomandibular raphe attaches to the hamular notch, with which the tensor veli palatini muscle is associated. Between the tensor veli palatini muscle and the levator veli palatini muscle, the afferent lymphatic channels run to the LRPN, as indicated in a previous report. Speculating from these anatomical correlations, LRPN metastasis may derive from the area of the pterygomandibular raphe, via the afferent lymphatic channels through the superior constrictor muscle or beside the tensor veli palatini muscle. In our own cases and two other cases with T4 carcinomas, the retromolar trigone and the pterygomandibular raphe were involved on sectional images or were clinically suspected. In two of the T4 cases, LRPN metastases were revealed on the initial sectional images. On the other hand, in our own cases with T2 carcinomas and the one case with a T4 carcinoma, LRPN metastases developed between five and eight months postoperatively.
Therefore, whenever carcinomas of the buccal mucosa develop to the retromolar trigone and the pterygomandibular raphe, the lateral retropharyngeal node should be examined carefully on sectional images.

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