Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas, USA.
Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas, USA.
Head Neck. 2022 May;44(5):1153-1163. doi: 10.1002/hed.27012. Epub 2022 Feb 25.
The management of solitary locoregional recurrence (sLRR) of head and neck squamous cell carcinoma (HNSCC) previously treated with radiotherapy (RT) is challenging. We aimed to identify characteristics associated with improved outcome.
We identified patients treated with non-sinus, mucosal HNSCC who initially received IMRT. We characterized overall survival (OS) and locoregional control (LRC). Multivariable analysis (MVA) on survival and patterns-of-failure were performed using Cox and Fine-Gray competing risks analysis.
We identified 90 patients with available follow-up. In total, 67 (74%) patients received curative-intent salvage, while 23 (26%) received palliative care. On MVA, significantly improved OS and LRC were associated with lower initial N-classification and use of salvage total laryngectomy (TL) or neck dissection (ND).
A nontrivial number of patients with sLRR cannot undergo salvage. Among patients treated with curative intent, TL or ND were clearly associated with improved OS and LRC.
头颈部鳞状细胞癌（HNSCC）经放疗（RT）治疗后发生孤立区域性局部复发（sLRR）的管理具有挑战性。本研究旨在确定与改善预后相关的特征。
我们确定了最初接受调强放疗（IMRT）治疗的非鼻窦黏膜型 HNSCC 患者。我们描述了总生存期（OS）和局部区域控制（LRC）情况。使用 Cox 和 Fine-Gray 竞争风险分析进行生存和失败模式的多变量分析（MVA）。
我们确定了 90 例可随访的患者。共有 67 例（74%）患者接受了根治性挽救治疗，23 例（26%）患者接受了姑息治疗。MVA 显示，初始 N 分类较低和使用挽救性全喉切除术（TL）或颈部清扫术（ND）与 OS 和 LRC 显著改善相关。
相当一部分 sLRR 患者无法进行挽救治疗。在接受根治性治疗的患者中，TL 或 ND 明显与 OS 和 LRC 改善相关。
