Salvage surgery for oropharyngeal cancer needs due consideration

Aug 9 2012

By Sarah Guy, MedWire Reporter

Japanese study results indicate a 5-year overall survival rate of 49% for oropharyngeal cancer (OPC) patients treated with salvage surgery after initial treatment with chemoradiotherapy (CRT) has failed.

However, the findings also show that this route leads to higher numbers of patients needing a feeding tube compared with those treated only with CRT.

The researchers say that despite this, "it is a fact that salvage surgery is the only curative treatment for the patients with recurrence after CRT in most cases," and that their results "should be given adequate consideration when the initial treatment method for OPC is decided."

Akihiro Homma, from Hokkaido University Graduate School of Medicine in Sapporo, and colleagues used data from the Head and Neck Cancer Study Group in Japan, including 523 patients with OPC, to investigate rates of treatment failure, salvage surgery, and survival for the 170 who were treated with CRT.

After a median follow up of 4.4 years, 3- and 5-year overall survival rates for patients treated initially with CRT were 75.8% and 67.1%, respectively, and 35 (21%) patients experienced local recurrence or residual disease a median 126 days after CRT. The 3- and 5-year overall survival rates for these latter patients were 61.8% and 49.1%, respectively.

Of those patients whose disease recurred, 11 underwent salvage therapy, note Homma and co-authors in the International Journal of Clinical Oncology. The surgery was successful in eight of these patients, they add.

The team reports that overall survival rates were significantly higher for patients treated with salvage surgery than for those treated with other methods, including radiotherapy. However; survival rates were still significantly lower in all those with disease recurrence than in those without.

While no deaths occurred among salvage surgery patients, five required feeding-tube support after the procedure, compared with two patients who needed it after CRT. Furthermore, three patients needed their larynxes to be removed during surgery.

"Considering the difficulty of salvage surgery, the initial treatment method for OPC should be decided carefully and the limitations of salvage surgery should be fully considered," Homma and co-workers conclude.

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