Development of a Patient-Reported Outcome Measure for Recurrent or Metastatic Head-and-Neck Cancer: Management of Recurrent Head-and-Neck Squamous Cell Carcinoma

Abstract

However, a significant percentage of these patients have persistent or recurrent disease and undergo salvage surgery as a secondary curative option. Surgery after radiation or chemoradiation is, however, associated with significantly higher morbidity rates when compared with primary surgical intervention. Hyperbaric oxygen therapy (HBOT) has been widely studied in the area of wound healing with promising results in the prevention of osteoradionecrosis, treatment of diabetic wounds and improved tissue perfusion in previously irradiated tissue. However, the evidence supporting the efficacy of its use for the prevention of post-operative wound complications in the area of salvage surgery remains limited. The primary objective of the study is to assess the efficacy of HBOT in the prevention of post-operative complications within the study population. Materials/Methods: 175 patients who underwent a clean-contaminated head and neck procedure following previous radiation or chemoradiation treatment for head and neck cancer from January 2006 to June 2013 were identified at a large academic tertiary care center. 134 of these patients did not receive post-operative HBOT and were designated for the control cohort. 41 patients received prophylactic post-operative HBOT and were designated for the study cohort. Patient co-morbidities, clinicopathologic data, and morbidity outcomes were analyzed. Results: The control and study cohorts were statistically matched in age, gender, history of previous chemotherapy, and time between completion of radiation therapy and surgical intervention. The overall rates of surgical complications in the control and study cohorts were 43% and 48%, respectively (p Z 0.59). The rates of major surgical complications, which resulted in significant morbidity or increased hospital stay to the patient, were 21% and 22% in the control and study cohorts, respectively (p Z 0.78). Similarly, the length of hospital stay (p Z 0.88), need for additional surgical intervention (p Z 0.13) and hospital re-admission rates (p Z 0.66) were not statistically different between the two groups. The 2-year overall survival in the control cohort was 40% and 36% in the study cohort. Conclusions: Prophylactic HBOT following salvage surgery does not decrease rates of postoperative complications, length of hospital stay or need for additional surgical intervention. Author Disclosure: A. Marcinow: None. T. Teknos: None. A. Agrawal: None. E. Ozer: None. R. Carrau: None. D. Schuller: None. M. Old: None.