Department of Radiation Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Eur Arch Otorhinolaryngol. 2020 Jan;277(1):261-268. doi: 10.1007/s00405-019-05676-2. Epub 2019 Oct 10.
Recurrent head and neck squamous cell carcinoma (HNSCC) after chemoradiation is a challenging clinical problem. Salvage surgery (SS) is often extensive and mutilating. Oncological outcomes of SS are relatively well known, but little is published about the course of disease after the first recurrence, especially in patients without salvage possibilities. The aim of this study was to analyze the course of disease in patients with recurrent HNSCC after chemoradiation.
We retrospectively analyzed and descriptively reported the disease course in 198 patients with recurrent HNSCC after chemoradiation in the time period after the first recurrence. We scored any type of event, salvage treatment, systemic treatment and overall survival (OS).
Of the 198 patients with recurrent HNSCC, salvage surgery was attempted in 104 (53%). SS was more frequently given in patients with recurrent laryngeal cancer, isolated regional failure (p < 0.001) and HPV-positive disease (p = 0.09). The 2-year OS of the whole group was 31% and was significantly different by tumor site, type of failure and SS. HPV-positive disease and salvaged recurrences were significantly predictive for better survival. One third of that salvaged patients was still alive without second recurrence. Median survival in patients that received any palliative systemic treatment without surgery, compared to those were no treatment was given, was 6 and 3 months, respectively (p = 0.006).
Main factors influencing the course of disease in recurrent HNSCC are the possibilities for SS and HPV-status. Therefore, SS should always be considered and discussed. In patients without possibilities for SS, overall survival is 3-6 months.
放化疗后复发性头颈部鳞状细胞癌（HNSCC）是一个具有挑战性的临床问题。挽救性手术（SS）通常广泛且具有破坏性。SS 的肿瘤学结果相对已知，但关于首次复发后疾病过程的报道很少，尤其是在没有挽救可能的患者中。本研究旨在分析放化疗后复发性 HNSCC 患者的疾病过程。
我们回顾性分析了 198 例放化疗后复发性 HNSCC 患者的疾病过程，这些患者在首次复发后接受了治疗。我们对任何类型的事件、挽救性治疗、全身治疗和总生存（OS）进行评分。
在 198 例复发性 HNSCC 患者中，有 104 例（53%）尝试了 SS。SS 更常应用于复发性喉癌、孤立性区域性失败（p<0.001）和 HPV 阳性疾病患者（p=0.09）。全组患者的 2 年 OS 为 31%，肿瘤部位、失败类型和 SS 显著不同。HPV 阳性疾病和挽救性复发是生存的显著预测因素。三分之一接受挽救性治疗的患者没有再次复发仍存活。与未接受任何姑息性全身治疗的患者相比，未接受治疗的患者的中位生存时间分别为 6 个月和 3 个月（p=0.006）。
影响复发性 HNSCC 疾病过程的主要因素是 SS 和 HPV 状态的可能性。因此，应始终考虑并讨论 SS。对于没有 SS 可能的患者，总生存时间为 3-6 个月。
