Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation

Joris B. W. Elbers, Lars I. Veldhuis, Patrick A. Bhairosing, Ludi E. Smeele, Katarzyna Jóźwiak, Michiel W. M. van den Brekel, Marcel Verheij, Abrahim Al-Mamgani, Charlotte L. Zuur

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Purpose: Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma (HNSCC) is known to result in poor prognosis. As there are only small and heterogeneous studies available with wide variety in outcome measures, our purpose was to select and pool literature according to specific criteria. Methods: Systematic review and meta-analysis of clinical outcome after salvage surgery for recurrent advanced stage HNSCC following primary radiotherapy or chemoradiation. Results: 16 of 3956 screened studies were included for analysis (729 patients). Pooled 5-year OS was 37% (95% CI 30–45%, 12 studies, 17 outcome measurements, 540 patients). Outcome was presented for larynx (6 studies, 397 patients), hypopharynx (2 studies, 47 patients), larynx and hypopharynx combined (3 studies, 69 patients) or separately (1 study, 134 patients), oral cavity (1 study, 11 patients), oropharynx (1 study, 34 patients) and multiple subsites combined (2 studies, 37 patients). There was no significant difference in survival outcome between subsites (p heterogeneity  = 0.8116). The pooled tumor-positive resection margin rate was 32% and pooled re-operation rate 17%. Complication rates from the pooled data were: fistulas 33%, wound infections 24% and flap failure 3%. Treatment-related mortality rate was 1% and mean hospital stay was 23 days. Conclusions: Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma after primary (chemo)radiotherapy is a good last resort curative treatment option, resulting in 37% overall survival at 5 years. As data from advanced stage non-laryngeal tumors were sparse, no solid conclusions can be drawn with regard to outcome differences between tumor subsites.
Original languageEnglish
Pages (from-to)647-655
JournalEuropean Archives of Oto-Rhino-Laryngology
Volume276
Issue number3
DOIs
Publication statusPublished - 14 Mar 2019
Externally publishedYes

Cite this

Elbers, J. B. W., Veldhuis, L. I., Bhairosing, P. A., Smeele, L. E., Jóźwiak, K., van den Brekel, M. W. M., ... Zuur, C. L. (2019). Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation. European Archives of Oto-Rhino-Laryngology, 276(3), 647-655. https://doi.org/10.1007/s00405-019-05292-0
Elbers, Joris B. W. ; Veldhuis, Lars I. ; Bhairosing, Patrick A. ; Smeele, Ludi E. ; Jóźwiak, Katarzyna ; van den Brekel, Michiel W. M. ; Verheij, Marcel ; Al-Mamgani, Abrahim ; Zuur, Charlotte L. / Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation. In: European Archives of Oto-Rhino-Laryngology. 2019 ; Vol. 276, No. 3. pp. 647-655.
@article{21ed796d86984693a14a8cd0c8b59b0e,
title = "Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation",
abstract = "Purpose: Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma (HNSCC) is known to result in poor prognosis. As there are only small and heterogeneous studies available with wide variety in outcome measures, our purpose was to select and pool literature according to specific criteria. Methods: Systematic review and meta-analysis of clinical outcome after salvage surgery for recurrent advanced stage HNSCC following primary radiotherapy or chemoradiation. Results: 16 of 3956 screened studies were included for analysis (729 patients). Pooled 5-year OS was 37{\%} (95{\%} CI 30–45{\%}, 12 studies, 17 outcome measurements, 540 patients). Outcome was presented for larynx (6 studies, 397 patients), hypopharynx (2 studies, 47 patients), larynx and hypopharynx combined (3 studies, 69 patients) or separately (1 study, 134 patients), oral cavity (1 study, 11 patients), oropharynx (1 study, 34 patients) and multiple subsites combined (2 studies, 37 patients). There was no significant difference in survival outcome between subsites (p heterogeneity  = 0.8116). The pooled tumor-positive resection margin rate was 32{\%} and pooled re-operation rate 17{\%}. Complication rates from the pooled data were: fistulas 33{\%}, wound infections 24{\%} and flap failure 3{\%}. Treatment-related mortality rate was 1{\%} and mean hospital stay was 23 days. Conclusions: Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma after primary (chemo)radiotherapy is a good last resort curative treatment option, resulting in 37{\%} overall survival at 5 years. As data from advanced stage non-laryngeal tumors were sparse, no solid conclusions can be drawn with regard to outcome differences between tumor subsites.",
author = "Elbers, {Joris B. W.} and Veldhuis, {Lars I.} and Bhairosing, {Patrick A.} and Smeele, {Ludi E.} and Katarzyna J{\'o}źwiak and {van den Brekel}, {Michiel W. M.} and Marcel Verheij and Abrahim Al-Mamgani and Zuur, {Charlotte L.}",
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Elbers, JBW, Veldhuis, LI, Bhairosing, PA, Smeele, LE, Jóźwiak, K, van den Brekel, MWM, Verheij, M, Al-Mamgani, A & Zuur, CL 2019, 'Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation' European Archives of Oto-Rhino-Laryngology, vol. 276, no. 3, pp. 647-655. https://doi.org/10.1007/s00405-019-05292-0

Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation. / Elbers, Joris B. W.; Veldhuis, Lars I.; Bhairosing, Patrick A.; Smeele, Ludi E.; Jóźwiak, Katarzyna; van den Brekel, Michiel W. M.; Verheij, Marcel; Al-Mamgani, Abrahim; Zuur, Charlotte L.

In: European Archives of Oto-Rhino-Laryngology, Vol. 276, No. 3, 14.03.2019, p. 647-655.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation

AU - Elbers, Joris B. W.

AU - Veldhuis, Lars I.

AU - Bhairosing, Patrick A.

AU - Smeele, Ludi E.

AU - Jóźwiak, Katarzyna

AU - van den Brekel, Michiel W. M.

AU - Verheij, Marcel

AU - Al-Mamgani, Abrahim

AU - Zuur, Charlotte L.

PY - 2019/3/14

Y1 - 2019/3/14

N2 - Purpose: Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma (HNSCC) is known to result in poor prognosis. As there are only small and heterogeneous studies available with wide variety in outcome measures, our purpose was to select and pool literature according to specific criteria. Methods: Systematic review and meta-analysis of clinical outcome after salvage surgery for recurrent advanced stage HNSCC following primary radiotherapy or chemoradiation. Results: 16 of 3956 screened studies were included for analysis (729 patients). Pooled 5-year OS was 37% (95% CI 30–45%, 12 studies, 17 outcome measurements, 540 patients). Outcome was presented for larynx (6 studies, 397 patients), hypopharynx (2 studies, 47 patients), larynx and hypopharynx combined (3 studies, 69 patients) or separately (1 study, 134 patients), oral cavity (1 study, 11 patients), oropharynx (1 study, 34 patients) and multiple subsites combined (2 studies, 37 patients). There was no significant difference in survival outcome between subsites (p heterogeneity  = 0.8116). The pooled tumor-positive resection margin rate was 32% and pooled re-operation rate 17%. Complication rates from the pooled data were: fistulas 33%, wound infections 24% and flap failure 3%. Treatment-related mortality rate was 1% and mean hospital stay was 23 days. Conclusions: Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma after primary (chemo)radiotherapy is a good last resort curative treatment option, resulting in 37% overall survival at 5 years. As data from advanced stage non-laryngeal tumors were sparse, no solid conclusions can be drawn with regard to outcome differences between tumor subsites.

AB - Purpose: Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma (HNSCC) is known to result in poor prognosis. As there are only small and heterogeneous studies available with wide variety in outcome measures, our purpose was to select and pool literature according to specific criteria. Methods: Systematic review and meta-analysis of clinical outcome after salvage surgery for recurrent advanced stage HNSCC following primary radiotherapy or chemoradiation. Results: 16 of 3956 screened studies were included for analysis (729 patients). Pooled 5-year OS was 37% (95% CI 30–45%, 12 studies, 17 outcome measurements, 540 patients). Outcome was presented for larynx (6 studies, 397 patients), hypopharynx (2 studies, 47 patients), larynx and hypopharynx combined (3 studies, 69 patients) or separately (1 study, 134 patients), oral cavity (1 study, 11 patients), oropharynx (1 study, 34 patients) and multiple subsites combined (2 studies, 37 patients). There was no significant difference in survival outcome between subsites (p heterogeneity  = 0.8116). The pooled tumor-positive resection margin rate was 32% and pooled re-operation rate 17%. Complication rates from the pooled data were: fistulas 33%, wound infections 24% and flap failure 3%. Treatment-related mortality rate was 1% and mean hospital stay was 23 days. Conclusions: Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma after primary (chemo)radiotherapy is a good last resort curative treatment option, resulting in 37% overall survival at 5 years. As data from advanced stage non-laryngeal tumors were sparse, no solid conclusions can be drawn with regard to outcome differences between tumor subsites.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30673847

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DO - 10.1007/s00405-019-05292-0

M3 - Review article

VL - 276

SP - 647

EP - 655

JO - European Archives of Oto-Rhino-Laryngology

JF - European Archives of Oto-Rhino-Laryngology

SN - 0937-4477

IS - 3

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