Surgical salvage of recurrent cancer of the head and neck

The therapeutic options and prognosis for recurrent squamous cell carcinoma of the upper aerodigestive tract vary greatly depending on site, extent of disease, and previous treatment. Surgical salvage represents the primary curative option when recurrent disease is resectable. Common factors associated with poor salvage surgery outcomes include positive surgical margins, lack of disease-free interval following previous definitive radiation therapy, advanced initial and recurrent tumor stage, and presence of concomitant recurrent neck disease. Surgical salvage of oropharyngeal and hypopharyngeal recurrences after primary chemoradiation therapy is associated with significant patient morbidity and poor long-term survival. Patients with laryngeal recurrences generally have the best comparative survival and functional outcomes, while patients with oral cavity recurrences have a relatively intermediate prognosis. Nasopharyngeal recurrences have often been treated with reirradiation, but surgical salvage represents the best option for small recurrences confined to the nasopharynx. Most patients with recurrent upper aerodigestive tract squamous cell carcinoma after previous aggressive therapy are not curable, and clinical judgment in determining which patients are appropriate candidates for salvage surgery is paramount.