Impact of surgical resection on survival in patients with advanced head and neck cancer involving the carotid artery

IMPORTANCE: The present study addresses the survival benefit of aggressive surgical treatment of head and neck cancer involving the carotid artery. OBJECTIVE: To assess survival outcomes in patients treated for advanced squamous cell carcinoma involving the carotid artery using different treatment strategies. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study at a tertiary care center of 44 consecutive patients with squamous cell carcinoma involving the carotid artery from 2005 to 2012 with a median follow-up of 12 months. The radiologist was blinded to the outcome of surgical procedures. INTERVENTIONS: Surgery with or without radiotherapy, and definitive chemoradiation. MAIN OUTCOMES AND MEASURES: Overall survival and rates of locoregional and distant failures. The hypothesis was formulated before data collection. RESULTS: Of 44 patients, 35 (80%) were treated with curative intent with surgery with or without adjuvant therapy (n = 27 [61%]) or definitive chemoradiation therapy (n = 8 [18%]), while 9 patients (21%) were treated in a palliative fashion. Patients treated with curative intent had improved overall survival (median survival, 13.5 months) compared with the palliative group (median survival, 3.6 months) (P = .001). Of patients treated with curative intent, those with previously untreated disease (n = 14 [40%]) had an improved outcome relative to patients with recurrent or persistent disease (n = 21 [60%]), with median survival of 38.7 and 9.6 months, respectively (P = .008). Patients were treated with curative intent using 3 different treatment strategies (ie, carotid artery resection with or without reanastamosis) (n = 6 [17%]), curative peeling with or without adjuvant therapy (n = 21 [60%]), and definitive chemoradiation therapy (n = 8 [23%]). Survival outcome was not significantly different between subgroups treated with curative intention (P = .47). When reviewed by a head and neck radiologist in a blinded fashion (n = 30), preintervention imaging had a positive predictive value of 72.7%for resectability of cancer involving the carotid artery. In cases with almost circumferential involvement (>270° ) and narrowing of the carotid artery, the disease was unresectable (n = 3). CONCLUSIONS AND RELEVANCE: Advanced head and neck cancer involving the carotid artery can be treated with curative intent with favorable results in most patients. If disease burden merits, an aggressive approach involving resection with or without reanastamosis of the carotid artery can be used without significant added morbidity.