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• W2015342556 abstract "The role of salvage total laryngectomy (TL) for local recurrence of head and neck cancer is clinically well described, but long-term (defined as 10-year) survival outcomes exist only in a single study published in 1992. Our institution is a referral center with considerable experience with salvage TL for such complex lesions. We retrospectively investigated long-term survival after TL for radiation therapy (RT) failures, and compared these data to patients receiving salvage TL after failed prior conservative surgery (CS). A search of our institution’s pathology database yielded 667 reports between 2/20/1985 and 12/12/2003 containing the word “laryngectomy.” Further review of these data yielded a total of 64 patients who underwent salvage TL: 53 instances of TL performed for RT failure, six TLs performed for CS failure, and five TLs performed after RT + CS. There were 55 men and 9 women. Median age at salvage TL was 64.4 years (range 35.5–82.3 years). Histology of salvage TL specimens was as follows: SCC (n = 55); no malignancy (n = 3); carcinoma (n = 2); and SCC in situ, adenosquamous carcinoma, mucoepidermoid carcinoma, and neuroendocrine carcinoma (each n = 1). Mean follow-up after TL was 7.2 years (median 6.8 years; range 0.2–17.4 years). Overall survival post-TL was calculated using the Kaplan-Meier method. Data regarding chemotherapy use prior to salvage TL at our institution were not sufficiently rigorous to allow its investigation. Five- and 10-year overall survival post-salvage TL were 65.2% and 37.7%, respectively. There was no significant survival difference between salvage TL after RT failure vs. after CS vs. after RT+CS (see graph; log-rank p = 0.50). Exclusion of the 3 patients who underwent salvage TL for radiographic evidence of recurrence and for whom final pathology revealed no malignancy did not significantly alter these data (log rank p = 0.55). For the 21 patients with lymph nodes assessed at the time of salvage TL, 9-year overall survival was 45.4% for N0 patients (n = 11) vs. 26.7% for N+ patients (n = 10) (log-rank p = 0.25). There was no difference in survival by sex (p = 0.75). These data correlate well with a 1992 report of the British Institute of Radiology which quoted a 40% 10-year survival for salvage TL after radiation failure. This study represents one of the rare mature clinical reports of salvage TL after RT. These data suggest that salvage TL after radiation failure is associated with equivalent long-term survival as salvage TL after RT+CS or after failure of CS alone. Nodal status at salvage TL did not significantly affect survival." @default.
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• W2015342556 date "2004-09-01" @default.
• W2015342556 modified "2023-10-16" @default.
• W2015342556 title "Failure after radiation therapy or conservative surgery in the head and neck: The role of salvage total laryngectomy" @default.
• W2015342556 doi "https://doi.org/10.1016/j.ijrobp.2004.07.140" @default.
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