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disease-free survival is the tumour depth more than 10 mm to be more effective than RT/CMT, despite the functional
[19]
and presence of neck metastases. Regarding the group of sequelae.
patients with recurrences after a long period of time free of
disease, the overall survival rate is higher in the group where Recurrences in hypopharynx show worse survival and
salvage surgery were performed than the group who receive functional results than other location. Symptoms may be
RT/CMT (84% vs. 52% after 5 years). non-specific and diagnosis can be delayed when the disease
is already advanced.
Analysing the group of patients who presented a short period
of free survival disease (FSD), the different survival after 5 Lymphatic spread is extensive and invasion of unresectable
years was lower, 38% vs. 31%; this result could be caused by an structures can be affected, Salvage surgery such as
early recurrence and infiltrative feature of the tumour, which pharyngo-laringectomy has dramatic side effects and a
determine a more aggressive behaviour that hides an occult high risk of postoperative complications. About 29% of
expansion more difficult to be eradicated. In conclusion, a patients present resectable recurrences at the moment of
short period of FSD is a negative prognosis factor. [20,21] diagnosis, maybe this situation determine that a few cases
could obtain benefits from salvage surgery.
Oropharyngeal recurrences are more common despite the
prevalence of HPV andits high sensitivity to CMT/RT. The rates Nevertheless, when surgery is possible, has demonstrated
of regional and distant failure in patients with HPV+ disease it is the best option to control de tumour. Some studies,
were 14% and 9% respectively in the Radiation Therapy showed how salvage surgery gets the same survival rates in
Oncology Group 0129 study. The survival after salvage patients previously treated with RT/CMT than patients who
[2]
surgery in recurrence cases is worse than for larynx and oral surgical treatment where done.
cavity neoplasms with a 5-year survivor of 13-28%.
Regional recurrence is another bad prognosis factor,
The salvage surgery or reirradiation in oropharynx often as well as the presence of distant metastasis. Even if,
results in high comorbidity including dysphagia, aspiration, isolated neck nodule is ease to be resected compared
dysarthria and permanent tracheostomy. The development to local recurrence, patients with regional recurrences
of microsurgical reconstruction has led the possibility to have better free tumour margin control at the surgical
perform salvage surgical treatment in more cases although moment (42% vs. 29%) rather than local recurrences.
the functional and QOL worsening are more controversial. But, present a worse long term survival (26% vs. 42%).
Also, overall survival decreases in operated necks than
Many authors referred that the time needed to return to others where surgery was not performed (18% vs. 32%). [23]
overall baseline health after a free flap reconstruction exceed Lim et al. found in rN2-rN3 stages that previous neck
[24]
the mean time of FSD before a second recurrence, despite the dissection and previous RT/CMT are the worst negative
controversies, it is obvious that microvascular reconstruction predictive factors.
demonstrates to be feasible and reliable, with low rate of
complications and a better impact on patients. As well as in RESULTS CONCERNING QOL
[22]
other tumours in oral cavity, the FSD until recurrence is one
of the most important prognostic factor. Nevertheless, in that According to the World Health Organization, health-related
cases, salvage surgery whenever is possible, demonstrates quality of life (HRQOL) is defined as the self-perception of

Table 1: Commonly used tools to collect patient-reported QOL outcomes in patients with HNSCC
QOL instrument-specific measures Description Domains measured
for head and neck cáncer
EORTC QOL Head and Neck Version 35-item, self-administered questionnaire to Pain swallowing, senses, speech, social
(EORTC QLQ-H%N35) be administered along with EORTC QLQ-30 eating, social contact and sexuality
Functional Assessment of Cancer 39-item, self-administered questionnaire General wellbeing questions (covering
Therapy-Head and Neck (FACT-H%N) 12 questions specific to head and neck physical, social/family, emotional and
cáncer functional parameters)
FACT-Head & Neck Symptom Index 10-item, self-administered questionnaire, a General wellbeing questions (covering
(FHNSI) subset of the FACT-H&N physical, social/family, emotional and
functional parameters)
Liverpool Oral Rehabilitation 40-item, self-administered questionnaire Eating, swallowing, dry mouth, saliva,
Questionnaire speech, appearance, social life and
interactions
MD Anderson Dysphagia Inventory 20-item self-administered questionnaire for Orophayrngeal dysphagia
(MDADI) patients with head and neck cáncer
The University of Washington Quality of 10 domains, self-administered questionnaire Pain, appearance, activity, recreation,
Life Instrument (UW-QOL) swallowing, chewing, speech, shoulder
problems, taste, saliva and general health
questions

QOL: quality of life; HNSCC: head and neck squamous cell carcinoma
206 Plast Aesthet Res || Volume 3 || June 24, 2016