Organ and Function Preservation: The Role of Surgery as the Optimal Primary Modality or as Salvage After Chemoradiation Failure
Section snippets
Surgery as the Primary Modality Therapy
In making the decision to recommend surgery as the primary treatment modality, the main technical consideration must be whether or not the tumor and any regional metastasis are amenable to complete resection. Resectability should not be confused with operability. Many patients may have tumors that can be effectively removed, but the patient's overall health or expectations for recovery and function may not be appropriate to warrant using surgical treatment. Likewise, advances in surgical and
The Oral Cavity and Oropharynx
The management of oral cavity and oropharynx cancers is most dependent on the extent of the involvement of the oral tongue, the base of the tongue, or the hard and soft palates. Treatment by either surgical resection or chemoradiation has the potential to lead to impairment in speech, deglutition, taste, salivary flow, and intraoral sensation. In most cases of resectable disease, surgical therapy should be considered when the amount of resected tissue will not lead to significant functional
Larynx and Hypopharynx
The goals of surgical therapy for larynx cancer are similar to those for primary chemoradiation including cure the cancer, preserve voice, maintain or improve swallowing, allow normal respiration, and, if possible, avoid a tracheostomal airway. Unfortunately, this will not be possible for all patients, irrespective of the primary treatment used. Patients with T4 cancers have overall good survival rates after primary treatment, ranging from 40% to 50%,1, 3, 23 but this is usually at the expense
Salvage Surgery After Chemoradiation Failure
The failure of primary chemoradiotherapy for head and neck SCC does not mean that ultimate oncologic control and cure is unattainable, but the long-term rates of locoregional control, disease-free status, and ultimately survival are certainly affected by whether the situation is one of tumor persistence or recurrence. Surgical salvage in the setting of cancer persistence, usually considered as a tumor present at the primary site or regional lymph nodes within 6 months of initial therapy, can be
Outcomes From Salvage Surgery
The efficacy of salvage surgery for persistent and recurrent disease is site and stage specific. Patients with recurrent tumors developing from early-stage primary cancers tend to have better rates of oncologic control and survival, as do recurrent laryngeal cancers even when originally staged T3 and T4.
Total laryngectomy has been the standard approach to salvage for recurrent laryngeal carcinoma. Use of this strategy, regardless of original tumor stage, yields 5-year survival rates of 45% to
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Cited by (15)
Functional Organ Preservation in Locally Advanced Laryngeal Squamous Cell Carcinoma: Is there a Role for Induction Chemotherapy?
2013, Clinical OncologyCitation Excerpt :Even if radiotherapy is successful in tumour eradication, laryngeal function may be impaired after treatment due to tumour destruction of large areas of the larynx. This puts patients at risk of aspiration with the potential need for long-term tracheostomy [32]. The resultant negative effect on health-related quality of life can be significant and greater than that after total laryngectomy and appropriate rehabilitation.
Advances in understanding of toxicities of treatment for head and neck cancer
2009, Oral OncologyCitation Excerpt :Previously for head and neck squamous cell carcinoma, standard treatment of surgery plus or minus radiotherapy and/or chemotherapy had a 4 year survival rate of 30–40%.8 In recent years, concurrent chemotherapy and radiotherapy has increasingly become the standard of care for locally advanced squamous cell carcinoma of the head and neck, with meta-analysis studies indicating a survival benefit of 8% at 2 and 5 years.9–11 Despite the therapeutic gain achieved by combined use of chemotherapy and radiotherapy, the reported toxicity associated with this treatment is high.12,13
Radiochemotherapy in Locally Advanced Squamous Cell Carcinomas of the Head and Neck
2009, Clinical OncologyCitation Excerpt :Surgery is, however, frequently limited by the anatomical extent of the tumour. In this situation, concomitant radiochemotherapy will replace surgery with the aim of organ preservation [12]. A major improvement in the treatment of advanced SCCHN has been the introduction of radiochemotherapy.