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March 1994

The Role of Surgery Following Radiotherapy Failure for Advanced Laryngopharyngeal CancerA Prospective Study

Author Affiliations

From the Departments of Otolaryngology, St Michaels Hospital (Drs Davidson and Briant) and Toronto (Ontario) Hospital (Dr Gullane), and the Department of Surgical Oncology, Division of Head and Neck Surgery (Drs Davidson, Briant, and Gullane), Department of Radiation Oncology (Dr Keane), and Clinical Trials Coordination Office (Ms Rawlinson), Princess Margaret Hospital, Toronto.

Arch Otolaryngol Head Neck Surg. 1994;120(3):269-276. doi:10.1001/archotol.1994.01880270017004

Background:  To comment on the use of surgery following radiotherapy failure for advanced laryngopharyngeal cancer.

Methods:  Of 212 participants, 88 underwent potentially curative surgical salvage following radiotherapy failure. These 88 patients were followed up prospectively for a median of 4.4 years following surgery; complications, recurrences, tumor measures, and survival were documented to facilitate a critical analysis.

Results:  Surgical complications developed in 48% of the patients, were most prevalent following pharyngectomy (P=.03), and were not influenced by the addition of a neck dissection (P=.76). Postsurgical survival was statistically associated with the TNM stage of the recurrent tumor and the site of recurrence (local or regional vs both), but was not associated with the TNM stage of the original tumor, time to recurrence, age, sex, or primary site. The overall 5-year postsurgical survival for this cohort was 35%. Utilizing a policy of primary radiotherapy, reserving surgery for radiotherapy failures, 41% of our patients retained functional larynges without reducing their overall survival.

Conclusions:  We suggest that recurrent tumors be restaged, as the measures of the recurrent tumor, not the tumor at original presentation, correlate best with survival following surgical intervention for tumor recurrence.(Arch Otolaryngol Head Neck Surg. 1994;120:269-276)