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Surgical rescue for persistent head and neck cancer after first-line treatment.

ABSTRACT: PURPOSE:Surgical rescue is a treatment option for persistent disease after first-line treatment treatment of head and neck cancer (HNC). METHODS:Patients with persistent HNC treated with rescue surgery between 2008 and 2016 were included. Patients who received a rescue neck dissection (ND only) and who received primary site surgery?±?ND were analysed separately (primary site surgery?±?ND). RESULTS:During the observation period, 35 patients received ND only and 17 primary site surgery?±?ND. No perioperative mortality was observed. In nine patients with ND only and 12 patients with primary site surgery?±?ND at least one complication was encountered. 41/52 (79%) patients had a complete response. Median overall survival of patients receiving rescue surgery was 56 months (95% CI 44-69 months). Median overall survival was best for patients with initial laryngeal and oropharyngeal cancer and worst for patients with hypopharyngeal cancer (p?=?0.02). Functional deficits following rescue surgery were mainly observed in the domains speech, nutrition, and shoulder/arm mobility. The risk of functional impairment was higher for patients with rescue surgery at the primary tumor site (OR 2.5?±?2; p?=?0.07). CONCLUSION:Rescue surgery offers patients with resectable, persistent disease a realistic chance to achieve long-term survival. Especially patients with laryngeal and oropharyngeal cancer profited from rescue surgery. Rescue neck dissection is an effective and safe procedure. Patients with rescue surgery at the primary tumor site?±?ND should expect complications and permanent functional impairment.

SUBMITTER: Steinbichler TB

PROVIDER: S-EPMC7160075 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Surgical rescue for persistent head and neck cancer after first-line treatment.

Steinbichler Teresa Bernadette TB Golm L L Dejaco D D Riedl D D Kofler B B Url C C Wolfram D D Riechelmann H H

European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 20200125 5

<h4>Purpose</h4>Surgical rescue is a treatment option for persistent disease after first-line treatment treatment of head and neck cancer (HNC).<h4>Methods</h4>Patients with persistent HNC treated with rescue surgery between 2008 and 2016 were included. Patients who received a rescue neck dissection (ND only) and who received primary site surgery ± ND were analysed separately (primary site surgery ± ND).<h4>Results</h4>During the observation period, 35 patients received ND only and 17 primary si ...[more]

PMID: 31982945

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Project description:ImportancePatients with head and neck cancers have comorbidities and other constitutional symptoms known to be associated with adverse postoperative outcomes, but the role of functional performance is not well studied.ObjectiveTo explore the addition of functional performance to other clinical factors for association with 3 patient outcomes: 30-day unplanned readmission (UR), 90-day medical complications, and overall survival (OS).Design, setting, and participantsThis retrospective cohort study was conducted in a single tertiary care center with patients surgically treated for squamous cell cancer of the lip, oral cavity, pharynx, or larynx from January 2012 to December 2016. All analysis took place between January 2018 and November 2018. Data from 2 registries were analyzed, supplemented with medical record review. Logistic regression analysis was used to explore association of preoperative functional performance with outcomes. Conjunctive consolidation was used to create a useful clinical severity staging system, which included functional performance (estimated from metabolic equivalent [MET] score: <4, light-intensity activities; ≥4 at least moderate-intensity activities); overall comorbidity severity; preoperative weight loss; and TNM tumor staging. Logistic regression was used to assess the prognostic accuracy of the clinical severity staging system for 30-day UR and 90-day complications, and Cox proportional hazard regression for OS.ExposuresAll patients underwent surgical treatment for head and neck cancer.Main outcomes and measuresThe primary outcomes were 30-day UR and 90-day complications; the secondary outcome was OS.ResultsFor the 657 patients included, the mean (SD) age was 62.0 (11.3) years; 73% were men (n = 477), and 88% were white (n = 580). A total of 75 (11%) had a 30-day UR; 204 (31%) developed a 90-day complication; and 127 (19%) patients died during the observation period. Individually, poor functional performance (<4 METs), high comorbidity burden, preoperative weight loss, and advanced TNM stage were associated with all 3 outcomes; the increased risk for each outcome ranged from 1.5 to 3.0 times the reference range. Using these 4 variables in combination, the 4-category clinical severity staging system demonstrated a strong association between severity stage and all 3 adverse outcomes: 30-day UR (C statistic, 0.63), 90-day complications (C statistic, 0.63), and OS (C statistic, 0.68).Conclusions and relevancePoor preoperative functional performance, high comorbidity burden, preoperative weight loss, and advanced tumor stage were all associated with worse patient outcomes after head and neck cancer surgery. The model incorporating all 4 of these factors developed in this study may facilitate patient-centered risk assessment and patient-physician shared preoperative decision making.

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Dataset Information

Surgical rescue for persistent head and neck cancer after first-line treatment.

Publications

Surgical rescue for persistent head and neck cancer after first-line treatment.

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