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Salvage surgery after failure of non surgical therapy for head and neck cancer
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Posters 65 poster SALVAGE SURGERY AFTER FAILURE OF NON SURGICAL THERAPY FOR HEAD AND NECK CANCER D. Dequanter~,R Lothaire I, Y. Lalami 2, R Gastelblum 3, M. Lemort~, A. AwadaS,T. Nguyen3,L. Vandevelde6,G. Andry ~ 11NSTITUTJULESBORDEr,Surgery, Brussels,Belgium, 2INSTITUTJULESBORDEr,Internal Medicine,Brussels,Belgium, 3]NSTITUTJULESBORDEr,Radiotherapy,Brussels,Belgium, 41NSTtTUTJULESBORDEr,Radiodiagnosis,Brussels,Belgium, SlNSTITUTJULESBORDEr,Chemotherapy,Brussels,Belgium, 61NSTITUTJULESBORDEr,O.R.L.,Brussels,Belgium Purpose/Objective: To evaluate the complication rate and the results of salvage surgery after (chemo)radiation of head and neck tumors. Materials/Methods: Retrospective analysis of pattern of failures and of complications after (chemo)radiation for organ preservation among 24 consecutive patients. Results: 24 Patients with recurrent head and neck tumor were reviewed (larynx n = I0; oral cavity n = 9; hypopharynx n = 5). The T stage at initial presentation was T/ in 5 cases, T2 in 13 cases, T3 in 5 cases and T4 in one case. 3 Patients were stage III and 7 patients were stage IV. 15 Patients underwent salvage surgery after radical radiation therapy; 9 patients after chemoradiotherapy. Recurrence disease developed at the primary site in 22 cases and in the neck in 2 cases after a mean follow-up of 11 months (3-136 months). Total laryngectomy was needed in 8 cases, a buccopharyngectomy in 7 cases, a pharyngolaryngectomy in 3 cases (with reconstruction by myocutaneous pectoral flap in two cases and a gastric pull-up in one case) and a pharyngectomy in 2 cases. A partial laryngectomy was only possible in 2 cases. A salvaged neck dissection was done in the 2 patient with neck recurrence. One postoperative death occurred following salvage surgery. The overall incidence of complications was 9•24 : fistula in 4 cases, hemorrhage in 3 cases, cardial rupture in one case, local infection in one case. After initial salvage treatment, recurrent local-regional and/or distant disease developed in 10124 patients after a mean follow-up of 4 months. Recurrence was at the primary site in 4 cases, in the neck alone in 3 cases, in the neck and primary site in 2 cases and in the neck with distant metastases in one case. 6/10 Patients died after re-recurrence despite salvage chemotherapy Conclusions: Despite associated morbidity, salvagesurgery achieves good results. Because of tumor progression, larynx preservation is seldom possible at the time of salvage. Patients with recurrence after salvage surgery have a poor prognosis.
66 poster STEREOTACTIC RADIOSURGERY VERSUS GOLD GRAIN IMPLANTATION IN SALVAGING LOCAL FAILURES OF NASOPHARYNGEAL CARCINOMA T.T. Chua ~, I. Wei 2,S. Sham', N. Hung 2,K. Au I 1QUEENMARYHOSPITAL,Clinical Oncology, Pokfulam, Hong Kong, 2QUEENMARYHOSPITAL,Surgery, Pokfulam, Hong Kong
from the plane of implantation. The two groups were individually matched for type of local failure (persistent or recurrent disease), prior local failure (no vs. yes) and retreatment T stage (rT1-2 vs. rT3). Patients treated by radiosurgery had more bulky tumor. Treatment outcome was compared in the two groups. Median follow-up was 42 months in the gold grain group and 41.5 months in the radiosurgery group. Results: Local control was better in the gold grain group with a 3-year local failure-free rate of 77.9% compared with 68.3% in the radiosurgery group, but the difference did not achieve statistical significance (p=0.098). When comparison was made in the subgroup with tumor volume _<5 cc, 3-year local failure-free rates were similar in both groups: 79.3% in the gold grain group compared with 72.4% in the radiosurgery group. The incidence of late complications was similar in both groups but neuroendocrine complications were more common in the radiosurgery group whereas headache and fistula were more common in the gold grain group. Conclusions: Both radiosurgery and gold grain implantation are effective salvage treatment for local failures of NPC. In patients with limited local failures, both types of salvage treatment yielded comparable high tumor control rates. 67 poster SUPRACRICOID LARYNGECTOMY AS SALVAGE SURGERY AFTER FAILURE OF RADIATION THERAPY J. Garcia Lorenzo, X. Le6n Vintro, M. LOpez Vilas, M. Quer Agusti, Z. Pifieiro Aguin HOSPITALDE LA SANTACREUI SANTPAU,Otorhinolaryngology, Barcelona,
Spain Purpose/Objective: Supracricoid laryngectomy can be an alternative to radical surgery in selected patients with local recurrence after radiotherapy when endoscopic treatment or more conservative external approaches are not indicated. Materials/Methods: From 1997 to 2005 nine salvage supracricoid laryngectomies after radiotherapy were performed in our center. All patients were male and aged 43 to 67 (mean 54.4 years.) Primary tumour was located in the glottis in eight cases and in the supraglottis in one case.The reconstruction method consisted in cricohyoidoepiglottopexy in six cases and cricohyoidopexy in three. Results: Salvage surgery achieved disease control in 89% of the cases. Laryngeal function was preserved in 78% of the patients. All patients were decannulated and recovered the ability to swallow. The mean cannulation and nasogastric feeding tube time were 11 and 27 days, respectively. The mean hospitalization time was 34 days. Six patients had wound healing complications that were solved without further surgery. One patient died of a complication associated with salvage treatment. Another patient died as a consequence of a new recurrence of the laryngeal tumour. When the study was closed 78% of the patients were alive with no evidence of disease. Conclusions: In conclusion, supracricoid laryngectomy is an effective technique as salvage treatment in selected cases of local recurrence after radiotherapy in patients with laryngeal cancer, and it can be an alternative to total laryngectomy when other salvage conservation methods are not indicated.
Purpose/Objective: Limited local failure of nasopharyngeal carci-
noma (NPC) can often be salvaged by reirradiation using different techniques. Gold grain implantation and stereotactic radiosurgery are two specialized radiation techniques that have been employed as salvage treatment of NPC but the relative efficacy is not known. We conducted a retrospective review comparing these two treatments in a matched cohort of NPC patients. Materials/Methods: A total of 74 patients with local failure of NPC were included in this retrospective analysis. Half of these patients received radiosurgery with a median dose of 12.5 Gy delivered to the 80% isodose line, the other half received gold grain implantation using a split-palatal approach with a calculated dose of 60 Gy at 0.5 cm
68 poster THE TREATMENT OF RECURRENT NASOPHARYNGEAL CANCER OVER A I0 YEAR PERIOD-A POPULATION BASED EXPERIENCE. F. Sheehan, D. Palma BC CANCERAGENCY,Radiation Ontology, Vancouver,Canada Purpose/Objective: The treatment of nasopharynggeal cancer continues to slowly evolve-largely as a result of improvements in technology resulting in better tumour definition, better staging and
Posters 65 poster SALVAGE SURGERY AFTER FAILURE OF NON SURGICAL THERAPY FOR HEAD AND NECK CANCER D. Dequanter~,R Lothaire I, Y. Lalami 2, R Gastelblum 3, M. Lemort~, A. AwadaS,T. Nguyen3,L. Vandevelde6,G. Andry ~ 11NSTITUTJULESBORDEr,Surgery, Brussels,Belgium, 2INSTITUTJULESBORDEr,Internal Medicine,Brussels,Belgium, 3]NSTITUTJULESBORDEr,Radiotherapy,Brussels,Belgium, 41NSTtTUTJULESBORDEr,Radiodiagnosis,Brussels,Belgium, SlNSTITUTJULESBORDEr,Chemotherapy,Brussels,Belgium, 61NSTITUTJULESBORDEr,O.R.L.,Brussels,Belgium Purpose/Objective: To evaluate the complication rate and the results of salvage surgery after (chemo)radiation of head and neck tumors. Materials/Methods: Retrospective analysis of pattern of failures and of complications after (chemo)radiation for organ preservation among 24 consecutive patients. Results: 24 Patients with recurrent head and neck tumor were reviewed (larynx n = I0; oral cavity n = 9; hypopharynx n = 5). The T stage at initial presentation was T/ in 5 cases, T2 in 13 cases, T3 in 5 cases and T4 in one case. 3 Patients were stage III and 7 patients were stage IV. 15 Patients underwent salvage surgery after radical radiation therapy; 9 patients after chemoradiotherapy. Recurrence disease developed at the primary site in 22 cases and in the neck in 2 cases after a mean follow-up of 11 months (3-136 months). Total laryngectomy was needed in 8 cases, a buccopharyngectomy in 7 cases, a pharyngolaryngectomy in 3 cases (with reconstruction by myocutaneous pectoral flap in two cases and a gastric pull-up in one case) and a pharyngectomy in 2 cases. A partial laryngectomy was only possible in 2 cases. A salvaged neck dissection was done in the 2 patient with neck recurrence. One postoperative death occurred following salvage surgery. The overall incidence of complications was 9•24 : fistula in 4 cases, hemorrhage in 3 cases, cardial rupture in one case, local infection in one case. After initial salvage treatment, recurrent local-regional and/or distant disease developed in 10124 patients after a mean follow-up of 4 months. Recurrence was at the primary site in 4 cases, in the neck alone in 3 cases, in the neck and primary site in 2 cases and in the neck with distant metastases in one case. 6/10 Patients died after re-recurrence despite salvage chemotherapy Conclusions: Despite associated morbidity, salvagesurgery achieves good results. Because of tumor progression, larynx preservation is seldom possible at the time of salvage. Patients with recurrence after salvage surgery have a poor prognosis.
66 poster STEREOTACTIC RADIOSURGERY VERSUS GOLD GRAIN IMPLANTATION IN SALVAGING LOCAL FAILURES OF NASOPHARYNGEAL CARCINOMA T.T. Chua ~, I. Wei 2,S. Sham', N. Hung 2,K. Au I 1QUEENMARYHOSPITAL,Clinical Oncology, Pokfulam, Hong Kong, 2QUEENMARYHOSPITAL,Surgery, Pokfulam, Hong Kong
from the plane of implantation. The two groups were individually matched for type of local failure (persistent or recurrent disease), prior local failure (no vs. yes) and retreatment T stage (rT1-2 vs. rT3). Patients treated by radiosurgery had more bulky tumor. Treatment outcome was compared in the two groups. Median follow-up was 42 months in the gold grain group and 41.5 months in the radiosurgery group. Results: Local control was better in the gold grain group with a 3-year local failure-free rate of 77.9% compared with 68.3% in the radiosurgery group, but the difference did not achieve statistical significance (p=0.098). When comparison was made in the subgroup with tumor volume _<5 cc, 3-year local failure-free rates were similar in both groups: 79.3% in the gold grain group compared with 72.4% in the radiosurgery group. The incidence of late complications was similar in both groups but neuroendocrine complications were more common in the radiosurgery group whereas headache and fistula were more common in the gold grain group. Conclusions: Both radiosurgery and gold grain implantation are effective salvage treatment for local failures of NPC. In patients with limited local failures, both types of salvage treatment yielded comparable high tumor control rates. 67 poster SUPRACRICOID LARYNGECTOMY AS SALVAGE SURGERY AFTER FAILURE OF RADIATION THERAPY J. Garcia Lorenzo, X. Le6n Vintro, M. LOpez Vilas, M. Quer Agusti, Z. Pifieiro Aguin HOSPITALDE LA SANTACREUI SANTPAU,Otorhinolaryngology, Barcelona,
Spain Purpose/Objective: Supracricoid laryngectomy can be an alternative to radical surgery in selected patients with local recurrence after radiotherapy when endoscopic treatment or more conservative external approaches are not indicated. Materials/Methods: From 1997 to 2005 nine salvage supracricoid laryngectomies after radiotherapy were performed in our center. All patients were male and aged 43 to 67 (mean 54.4 years.) Primary tumour was located in the glottis in eight cases and in the supraglottis in one case.The reconstruction method consisted in cricohyoidoepiglottopexy in six cases and cricohyoidopexy in three. Results: Salvage surgery achieved disease control in 89% of the cases. Laryngeal function was preserved in 78% of the patients. All patients were decannulated and recovered the ability to swallow. The mean cannulation and nasogastric feeding tube time were 11 and 27 days, respectively. The mean hospitalization time was 34 days. Six patients had wound healing complications that were solved without further surgery. One patient died of a complication associated with salvage treatment. Another patient died as a consequence of a new recurrence of the laryngeal tumour. When the study was closed 78% of the patients were alive with no evidence of disease. Conclusions: In conclusion, supracricoid laryngectomy is an effective technique as salvage treatment in selected cases of local recurrence after radiotherapy in patients with laryngeal cancer, and it can be an alternative to total laryngectomy when other salvage conservation methods are not indicated.
Purpose/Objective: Limited local failure of nasopharyngeal carci-
noma (NPC) can often be salvaged by reirradiation using different techniques. Gold grain implantation and stereotactic radiosurgery are two specialized radiation techniques that have been employed as salvage treatment of NPC but the relative efficacy is not known. We conducted a retrospective review comparing these two treatments in a matched cohort of NPC patients. Materials/Methods: A total of 74 patients with local failure of NPC were included in this retrospective analysis. Half of these patients received radiosurgery with a median dose of 12.5 Gy delivered to the 80% isodose line, the other half received gold grain implantation using a split-palatal approach with a calculated dose of 60 Gy at 0.5 cm
68 poster THE TREATMENT OF RECURRENT NASOPHARYNGEAL CANCER OVER A I0 YEAR PERIOD-A POPULATION BASED EXPERIENCE. F. Sheehan, D. Palma BC CANCERAGENCY,Radiation Ontology, Vancouver,Canada Purpose/Objective: The treatment of nasopharynggeal cancer continues to slowly evolve-largely as a result of improvements in technology resulting in better tumour definition, better staging and