Abstract
Simple SummaryExcept for HPV-induced cancers of the oropharynx, survival rates in patients with squamous cell carcinoma of the head and neck (HNSCC) have not changed substantially over the last decades. Salvage surgery plays an important role where primary treatment was unsuccessful since 50% of advanced-stage patients relapse after nonsurgical primary treatment. Depending on a variety of factors, a considerable number of patients in whom primary treatment was not successful can still be cured by salvage surgery. It is the goal of this review to elucidate these factors with the aim to counsel patients and their relatives realistically about the chances of being cured.
Highlights
Introduction and Limits in SalvageSurgery inFor the last 20–30 years, treatment of primary Head and Neck Cancers by radiotherapy (RT) or chemoradiation (CRT) has constantly been increasing and became a gold standard in many HNSCC
While in the 1960s, primary surgical treatment of laryngeal cancer was done in >90% of cases, it has decreased to ~50% nowadays. This is among other reasons attributable to landmark studies, such as the “VA-Study”, that offered comparable survival rates and a reasonably high rate of organ preservation in patients treated by induction chemotherapy and RT compared to patients treated primarily with surgery and adjuvant
Persistent/recurrent disease poses several challenges and, should be assessed systematically by a team experienced in the whole range of management options available, including surgical salvage, re-irradiation, chemotherapy, and palliative care [4]
Summary
For the last 20–30 years, treatment of primary Head and Neck Cancers by radiotherapy (RT) or chemoradiation (CRT) has constantly been increasing and became a gold standard in many HNSCC. While in the 1960s, primary surgical treatment of laryngeal cancer was done in >90% of cases, it has decreased to ~50% nowadays This is among other reasons attributable to landmark studies, such as the “VA-Study”, that offered comparable survival rates and a reasonably high rate of organ preservation in patients treated by induction chemotherapy and RT compared to patients treated primarily with surgery and adjuvant. The majority of HNSCC disease at Stage III or IV is primarily treated by a combination of surgery and radiotherapy (multimodal treatment). Persistent cancer is rather imprecisely defined as a lack of complete remission of a tumor in its primary site or regional lymph nodes within the initial “few months” after treatment termination (there is no uniform agreement to discriminate between persistence and recurrence).
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