Recurrent head and neck cancer: challenges and limitations

Abstract

Recurrent disease after surgical treatment for advanced stage head and neck cancer with or without chemotherapy and radiotherapy is not uncommon. Further surgical salvage of these recurrent cancers has remained a challenge for the head and neck surgeon. Over the last decade, at the University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, we have carried out surgical salvage for 377 patients who developed recurrent head and neck cancer after curative surgical resection, this included 174 (46%) patients who had postoperative radiotherapy. The primary tumour sites included the oral cavity, oropharynx, larynx and hypopharynx. The distribution pattern of recurrence was at primary site, around the terminal tracheostome following laryngectomy or laryngopharyngectomy, in the neck nodes and also a few patients with lung metastasis. The surgical salvage rates for these patients were 29% for local recurrence, 30% for tracheostomal recurrence, and 56% for recurrence in unilateral undissected neck, and 32% in unilateral previously dissected neck. The salvage rate for distant metastases in the lung was 11%. The 5-year tumour-free actuarial survival rate was 35% for local disease, 21% for tracheostomal recurrence, 32% for unilateral nodal recurrence in the undissected neck, and 18% for the previously dissected neck. When non-surgical means were employed for salvage, the mean survival period was only 6 months. No patients survived 5 years. The surgical salvage of recurrent head and neck cancers provides the best chance of eradicating the disease, and this treatment option is more effective when the recurrent disease is detected early.