The addition of chemotherapy (CT) to primary radiotherapy (RT) has a reported survival benefit of 4–8% but also increases toxicity leading to a more complication prone course if SS is needed. Since the emergence of organ preservation in advanced head and neck cancer there has been an increase in need for salvage surgery with various results. The dynamic field of head and neck cancer treatment, with developments as increasing incidence of HPV- positive oropharyngeal carcinoma (OPSCC) and related treatment paradigm shifts, has a significant impact on the role of SS.
Active physician driven surveillance is paramount in early detection of residual or recurrent disease to increase salvage rates.
Salvage surgery should not be considered a fallback option as the outcome is significantly worse than after primary surgery regardless of adjuvant therapy. Realistic expectations should be discussed with the patient as well as the best treatment strategy in each individual patient. Major complications postoperatively have to be anticipated and dealt with. Radicality, which greatly determines success, is often difficult to foresee after previous treatment. Since the introduction of organ preservation strategies and the rise of concomitant chemoradiation (CCRT) in advanced disease, challenges in SS have grown substantially due to toxicity and a tendency to poor healing. Salvage surgery (SS) for head and neck cancer is a much-addressed issue due to its complexity and high stakes for the individual patient.
0 kommentar(er)
