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RESULTS CONCERNING PROGNOSIS Some studies reveal a significant difference up to 2 years of
free disease survival withoutrecurrences (67% for stage II,
[14]
Every year, over 50,000 patients with HNSCC are diagnosed 33% for stage III and 22% for stage IV). Otherwise, a short
and, approximately 12,000 developed regional disease or interval without recurrences demonstrated an important
distant metastases in United States. Almost 60% of patients negative impact factor.
[7]
are diagnosed since the first moment as III/IV stage. From
30% to 50% of them have locally advanced disease which will Some studies included more than 500 patients, revealed
develop recurrences and 20-30% of them will exhibit distant 20% of differences of 5 years overall survival with a 9-month
metastases. interval and considering a short period of free survival
disease, probably the most important factor despite the
The treatment choices for patients with non-resectable tumour site. [15]
metastases are reduced to palliative care therapy, while the
main objective of patients with resectable tumours is curative, Previous computed tomography-scan is considered a poor
enhance the overall survival, get a better functional result and prognosis factor in patients with recurrences. Many patients
palliate the symptoms. showed a worst survival rate after recurrences (5 months
mean rate vs. 25 months). Although the explanation for this
[14]
When, the aerodigestive tract is involved can determinate result is already unknown, it seems like a good response after
many complications like dysphagia, airway obstruction and induction CMT anticipates a good response in the recurrence
speech impediments. The infiltrated skin generates chronic area. CMT can detect those patients with more aggressive
infections, painful and malodorous fistulae [Figure 1]. These recurrences. Alternatively, CMT could be a landmark for
are some of the reasons that determine the social and familiar advances stages where more intense previous therapy is
isolation despite the lack on the quality of life (QOL). required but with poor prognosis.

The reason of the high incidence of recurrences is still Factors depending on tumour location
unknown. While the rate of smokers is decreasing, the Comparing oropharynx with hypopharynx, the larynx
incidence of patients HPV+ is raising. It seems like cases tumours developed more early symptoms and could be
HPV+ present a low rate of secondary tumours and is not detected in an early and more treatable stage. The drainage
related with the typical cancerization field. Anyway, is well pathways are well established and the lymph dissemination
known the connection between the high risk of recurrence is more predictable. These factors can be observed in cases
and the development of radio-induced tumours with HPV+ of recurrences and total laringectomy is already a curative
cases during a long period of time. [8-10] therapy with a 5-year overall survival about 68-70%. [16,17]

Recurrences differ from primary tumour because they are The favourable prognosis in patients with recurrent laryngeal
typically more infiltrative and multifocal, it is very common disease is the reason why many groups propose a more
to find disseminated tumours outside the radiated field and conservative surgical treatment, such as, partial laringectomy
[11]
the surgically area. Despite the effort to find wide resection performed with transoral laser microsurgery or open partial
[17]
margins, the presence of fibrosis and the distortion of the laryngectomy. Ganly et al. referred that stages rT1-T2 enable
anatomy make us very difficult to get free margins. to be surgically treated with partial laringectomy have a 5-year
overall survival of 89%, meanwhile, those who require a total
PROGNOSIS FACTORS OF laringectomy due to a more aggressive tumour behaviour,
RECURRENCES IN HNSCC the overall survival decrease to 50%. Obviously, patients with
early stages show, not only, a better survival rate, also a better
functional larynx preservation.
One of the most important criteria is determine the real
curative expectation of patients. There are many studies Sinclair et al. demonstrated that intelligible speech could be
[18]
published with ambiguous results because the heterogeneity preserved in 66-71% of patients in which conservative larynx
of the data, the different location sites of the tumours and the therapies were performed. It supposes a better QOL in this
therapies included. group of patients. [18]

Factors depending on the patient Oral recurrences are easier to detect, but the prognosis
Comorbidity of the patient is a determinant factor for the is poorer than other location, probably the reason is the
prognosis. An excessive loss of weight, high comorbid different lymphatic drainage pathways, biological behaviour
diseases, low cognitive level, lack of social support, the low and the easy dissemination to many other areas of the oral
quality of life and the continuing alcohol and tobacco abuse cavity.
are some of the most frequent adverse prognosis factors. [12,13]
In contrast to laryngeal recurrences, the oral cavity recurrence
Factors depending on the tumour occurs more frequently in distant sites. According to some
The most important factor is the stage of the recurrence. studies, one of the determinant prognostic factor for long
Plast Aesthet Res || Volume 3 || June 24, 2016 205