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Original Article
December 2000

Salvage Surgery After Failure of Nonsurgical Therapy for Carcinoma of the Larynx and Hypopharynx

Author Affiliations

From the Clinic of Otorhinolaryngology–Head and Neck Surgery (Drs Stoeckli, Pawlik, Huber, and Schmid) and the Clinic of Radiation Oncology (Dr Lipp), University Hospital Zurich, Zurich, Switzerland.

Arch Otolaryngol Head Neck Surg. 2000;126(12):1473-1477. doi:10.1001/archotol.126.12.1473

Background  For larynx preservation, radiotherapy is gaining popularity for primary treatment of laryngeal and hypopharyngeal cancer, reserving surgery for salvage.

Objective  To analyze the outcome of salvage surgery after failure of primary radiotherapy.

Design  Nine-year retrospective outcome analysis.

Setting  University referral center.

Patients  Fifty-four patients with squamous cell carcinoma of the larynx (n = 39) or hypopharynx (n = 15).

Results  For laryngeal cancer, mean interval from radiation to detection of recurrence was 14.5 months (range, 2-66 months). Twenty-three patients (59%) presented with a more advanced tumor stage after radiation than at the initial evaluation. Total laryngectomy was needed in 36 patients (92%). Disease-specific 5-year survival rate was 63%. Survival of patients with small recurrent tumors was statistically significantly better than those with advanced tumors (P = .004). For hypopharyngeal cancer, mean interval from radiation to detection of the recurrence was 10.6 months (range, 3-40 months). Total laryngopharyngectomy was needed in 8 of 9 patients with local recurrrence; neck dissection, in 6 patients with regional recurrence. Disease-specific 5-year survival rate was only 20%. Recurrent tumor and node stages did not influence the outcome. Patients with regional recurrences did no better than those with local ones.

Conclusions  Salvage surgery in laryngeal cancer achieves good results, especially for small recurrences. Because of tumor progression, larynx preservation is seldom possible at the time of salvage. Salvage surgery in hypopharyngeal cancer shows poor survival regardless of tumor stage and despite radical surgical procedures, and can be recommended only for carefully selected patients.