Salvage of Recurrence after Surgery and Adjuvant Therapy

A Multi-institutional Study

Joseph Zenga, Evan Graboyes, Tyler Janz, Virgina Drake, Eleni Rettig, Shaun Desai, Christopher Nickel, Sepehr Shabani, Tapan Padhya, Mario Scarpinato, Michael Stadler, Becky Massey, Bruce Campbell, Monica Shukla, Musaddiq Awan, Christopher J. Schultz, Stuart Wong, Ryan S. Jackson, Patrick Pipkorn

Research output: Contribution to journalArticle

Abstract

Objectives: To determine the oncologic outcomes of patients undergoing salvage surgery for recurrent oral cavity squamous cell carcinoma (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC) after initial treatment with surgery and adjuvant therapy. Study Design: Retrospective case series with chart review. Setting: Five academic tertiary care centers. Subjects and Methods: Patients included those with OCSCC and OPSCC who were initially treated with surgery and adjuvant therapy between 2000 and 2015 and underwent salvage surgery for local and/or regional recurrence. Results: A total of 102 patients were included (76% OCSCC, 24% OPSCC). Five-year overall survival was 31% (95% CI, 21%-41%) and was significantly improved among patients with human papillomavirus–associated oropharyngeal tumors (hazard ratio [HR], 0.34; 95% CI, 0.11-0.98) and significantly worse for those with postoperative positive margins (HR, 2.65; 95% CI, 1.43-4.93). Adjuvant (chemo)reirradiation was not associated with disease control or survival regardless of margin status. Combined locoregional recurrence was significantly correlated with a positive margin resection (HR, 5.75; 95% CI, 1.94-17.01). Twenty-five patients (25%) underwent a second salvage surgical procedure, of whom 8 achieved long-term disease control. Conclusion: Patients presenting with resectable recurrence after initial therapy with surgery and adjuvant therapy have a reasonable salvage rate when a negative margin resection can be attained. Patients with postoperative positive margins have poor survival outcomes that are not significantly improved with adjuvant (chemo)reirradiation. Those with combined locoregional recurrence are at particularly high risk for postoperative positive margins. The functional consequences of salvage surgery and its effect on quality of life are critical in decision making and require further investigation.

Original languageEnglish (US)
JournalOtolaryngology - Head and Neck Surgery (United States)
DOIs
StatePublished - Jan 1 2019

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Squamous Cell Carcinoma
Recurrence
Mouth
Therapeutics
Survival
Tertiary Care Centers
Decision Making
Retrospective Studies
Quality of Life
Neoplasms
Margins of Excision
Re-Irradiation

Keywords

  • head and neck
  • oral cavity
  • oropharynx
  • salvage surgery
  • squamous cell carcinoma

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Salvage of Recurrence after Surgery and Adjuvant Therapy : A Multi-institutional Study. / Zenga, Joseph; Graboyes, Evan; Janz, Tyler; Drake, Virgina; Rettig, Eleni; Desai, Shaun; Nickel, Christopher; Shabani, Sepehr; Padhya, Tapan; Scarpinato, Mario; Stadler, Michael; Massey, Becky; Campbell, Bruce; Shukla, Monica; Awan, Musaddiq; Schultz, Christopher J.; Wong, Stuart; Jackson, Ryan S.; Pipkorn, Patrick.

In: Otolaryngology - Head and Neck Surgery (United States), 01.01.2019.

Research output: Contribution to journalArticle

Zenga, J, Graboyes, E, Janz, T, Drake, V, Rettig, E, Desai, S, Nickel, C, Shabani, S, Padhya, T, Scarpinato, M, Stadler, M, Massey, B, Campbell, B, Shukla, M, Awan, M, Schultz, CJ, Wong, S, Jackson, RS & Pipkorn, P 2019, 'Salvage of Recurrence after Surgery and Adjuvant Therapy: A Multi-institutional Study', Otolaryngology - Head and Neck Surgery (United States). https://doi.org/10.1177/0194599819830664
Zenga, Joseph ; Graboyes, Evan ; Janz, Tyler ; Drake, Virgina ; Rettig, Eleni ; Desai, Shaun ; Nickel, Christopher ; Shabani, Sepehr ; Padhya, Tapan ; Scarpinato, Mario ; Stadler, Michael ; Massey, Becky ; Campbell, Bruce ; Shukla, Monica ; Awan, Musaddiq ; Schultz, Christopher J. ; Wong, Stuart ; Jackson, Ryan S. ; Pipkorn, Patrick. / Salvage of Recurrence after Surgery and Adjuvant Therapy : A Multi-institutional Study. In: Otolaryngology - Head and Neck Surgery (United States). 2019.
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abstract = "Objectives: To determine the oncologic outcomes of patients undergoing salvage surgery for recurrent oral cavity squamous cell carcinoma (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC) after initial treatment with surgery and adjuvant therapy. Study Design: Retrospective case series with chart review. Setting: Five academic tertiary care centers. Subjects and Methods: Patients included those with OCSCC and OPSCC who were initially treated with surgery and adjuvant therapy between 2000 and 2015 and underwent salvage surgery for local and/or regional recurrence. Results: A total of 102 patients were included (76{\%} OCSCC, 24{\%} OPSCC). Five-year overall survival was 31{\%} (95{\%} CI, 21{\%}-41{\%}) and was significantly improved among patients with human papillomavirus–associated oropharyngeal tumors (hazard ratio [HR], 0.34; 95{\%} CI, 0.11-0.98) and significantly worse for those with postoperative positive margins (HR, 2.65; 95{\%} CI, 1.43-4.93). Adjuvant (chemo)reirradiation was not associated with disease control or survival regardless of margin status. Combined locoregional recurrence was significantly correlated with a positive margin resection (HR, 5.75; 95{\%} CI, 1.94-17.01). Twenty-five patients (25{\%}) underwent a second salvage surgical procedure, of whom 8 achieved long-term disease control. Conclusion: Patients presenting with resectable recurrence after initial therapy with surgery and adjuvant therapy have a reasonable salvage rate when a negative margin resection can be attained. Patients with postoperative positive margins have poor survival outcomes that are not significantly improved with adjuvant (chemo)reirradiation. Those with combined locoregional recurrence are at particularly high risk for postoperative positive margins. The functional consequences of salvage surgery and its effect on quality of life are critical in decision making and require further investigation.",
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T2 - A Multi-institutional Study

AU - Zenga, Joseph

AU - Graboyes, Evan

AU - Janz, Tyler

AU - Drake, Virgina

AU - Rettig, Eleni

AU - Desai, Shaun

AU - Nickel, Christopher

AU - Shabani, Sepehr

AU - Padhya, Tapan

AU - Scarpinato, Mario

AU - Stadler, Michael

AU - Massey, Becky

AU - Campbell, Bruce

AU - Shukla, Monica

AU - Awan, Musaddiq

AU - Schultz, Christopher J.

AU - Wong, Stuart

AU - Jackson, Ryan S.

AU - Pipkorn, Patrick

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N2 - Objectives: To determine the oncologic outcomes of patients undergoing salvage surgery for recurrent oral cavity squamous cell carcinoma (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC) after initial treatment with surgery and adjuvant therapy. Study Design: Retrospective case series with chart review. Setting: Five academic tertiary care centers. Subjects and Methods: Patients included those with OCSCC and OPSCC who were initially treated with surgery and adjuvant therapy between 2000 and 2015 and underwent salvage surgery for local and/or regional recurrence. Results: A total of 102 patients were included (76% OCSCC, 24% OPSCC). Five-year overall survival was 31% (95% CI, 21%-41%) and was significantly improved among patients with human papillomavirus–associated oropharyngeal tumors (hazard ratio [HR], 0.34; 95% CI, 0.11-0.98) and significantly worse for those with postoperative positive margins (HR, 2.65; 95% CI, 1.43-4.93). Adjuvant (chemo)reirradiation was not associated with disease control or survival regardless of margin status. Combined locoregional recurrence was significantly correlated with a positive margin resection (HR, 5.75; 95% CI, 1.94-17.01). Twenty-five patients (25%) underwent a second salvage surgical procedure, of whom 8 achieved long-term disease control. Conclusion: Patients presenting with resectable recurrence after initial therapy with surgery and adjuvant therapy have a reasonable salvage rate when a negative margin resection can be attained. Patients with postoperative positive margins have poor survival outcomes that are not significantly improved with adjuvant (chemo)reirradiation. Those with combined locoregional recurrence are at particularly high risk for postoperative positive margins. The functional consequences of salvage surgery and its effect on quality of life are critical in decision making and require further investigation.

AB - Objectives: To determine the oncologic outcomes of patients undergoing salvage surgery for recurrent oral cavity squamous cell carcinoma (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC) after initial treatment with surgery and adjuvant therapy. Study Design: Retrospective case series with chart review. Setting: Five academic tertiary care centers. Subjects and Methods: Patients included those with OCSCC and OPSCC who were initially treated with surgery and adjuvant therapy between 2000 and 2015 and underwent salvage surgery for local and/or regional recurrence. Results: A total of 102 patients were included (76% OCSCC, 24% OPSCC). Five-year overall survival was 31% (95% CI, 21%-41%) and was significantly improved among patients with human papillomavirus–associated oropharyngeal tumors (hazard ratio [HR], 0.34; 95% CI, 0.11-0.98) and significantly worse for those with postoperative positive margins (HR, 2.65; 95% CI, 1.43-4.93). Adjuvant (chemo)reirradiation was not associated with disease control or survival regardless of margin status. Combined locoregional recurrence was significantly correlated with a positive margin resection (HR, 5.75; 95% CI, 1.94-17.01). Twenty-five patients (25%) underwent a second salvage surgical procedure, of whom 8 achieved long-term disease control. Conclusion: Patients presenting with resectable recurrence after initial therapy with surgery and adjuvant therapy have a reasonable salvage rate when a negative margin resection can be attained. Patients with postoperative positive margins have poor survival outcomes that are not significantly improved with adjuvant (chemo)reirradiation. Those with combined locoregional recurrence are at particularly high risk for postoperative positive margins. The functional consequences of salvage surgery and its effect on quality of life are critical in decision making and require further investigation.

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KW - oropharynx

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KW - squamous cell carcinoma

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