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Table 1: Selected studies from systematic review and meta-analysis
Recurrent Overall Overall Local Regional Loco-regional 5-year overall survival
patients´series series recurrence recurrence recurrence recurrence after salvage surgery
size (n) size (n) rate (%) n (%) n (%) n (%) (%)
Schwartz et al. 2000 38 135* 28% - - - 21%
[3]
[4]
Kowalski 2002 214 513 41.7%* - 82 (38.3%) - 31-36%
[1]
Lin et al. 2004 56 191 29.3%* - - - 38-60%
[5]
Agra et al. 2006 246 - - 154 (62.6%) 59 (24%) 33 (13.4%) 32%
[6]
Koo et al. 2006 36 127 28% 15 (41.7%) 13 (36.1%) 3 (8.3%) 38%
Brown et al. 2007 98 462 21% 48 (59.2%) 34 (34.7%) 16 (16.3%) -
[7]
[8]
Liao et al. 2008 272 953 28.5% 133 (48.9%) 139 (51.1%) - 36%
[9]
Lim and Choi 2008 16 76 21% 5 (31.2%) 8 (50%) 2 (12.5%) 36%
[17]
Zafereo et al. 2009 434 1681 26% 199 (45.8%) 53 (12.2%) - 28%
[10]
Kernohan et al. 2010 117 533 22%* 39 (33.3%) 38 (32.5%) - 50%
Sklenicka et al. 2010 24 157 15% 11 (45.8%) 9 (37.5%) 1 (4.1%) 48%
[11]
Kostrzewa et al. 2010 72 - - - - - 44%
[12]
[13]
Goto et al. 2016 69 - - - - - 48-86%
Overall results a 1,692 - 26% 47.3% 35.1% 10.9% 40.2%
(González-García, (37.5-42.9%)
2016)
*Indirectly calculated by the author from data provided in respective publications; Overall results from recalculation of variables in previous
a
analyzed studies, considering only articles with available data in relation to each particular variable
for inclusion/exclusion criteria and treatment protocols survival after recurrence than those not previously
among institutions. All these features make quantitative treated, and concluded that patients with neck recurrences
analysis of results difficult if bias wants to be dismissed. have a poor prognosis despite salvage surgery.
The following paragraphs in the results section will deal
with the description of the main results provided by the In a series of 191 patients receiving curative intended
[1]
authors of the 13 selected papers in a chronologic manner surgery for SCC of the oral cavity, Lin et al. isolated 56
[Table 1]. Further qualitative analysis of these results will patients with recurrence, for whom salvage surgery was
be individually approached in the discussion section. performed. By defining “early recurrence” as a localized
tumor less than 4 cm, without bone invasion in the
Up in the beginning of the 21st century, Schwartz et al. in a computed tomography (CT)-scan, and “late recurrence”
[3]
retrospective study about 38 patients that had developed as a tumor larger than 4 cm with bone invasion that
recurrence of oral cavity SCC, reported an overall presented as a lymph neck node or a diffuse invasion in
recurrence rate of 28%, with a local recurrence of 58%, a the CT scan, they found a 5-year disease-free survival rate
loco-regional recurrence of 27% and an isolated regional of 24%, with 32% of patients free of disease if an early
recurrence of 16%. With an overall salvage cure rate of recurrence was detected, in comparison to only 16% of
21%, they found that those patients receiving surgery patients free of disease if a late recurrence was treated.
as salvage treatment modality significantly improved They also reported an acceptable overall 5-year survival
in terms of survival time with respect to those treated rate of 60% for early recurrences, in contrast to 38% if
with chemotherapy and/or RT, while cure rate trended recurrences were late.
to signification (P = 0.08). Interestingly, primary tumor
[5]
staging was predictive for improved survival time but not Agra et al., in 2006, studied 246 patients with recurrent
for improved cure rate, while recurrent tumor staging SCC of the oral cavity and oropharynx who underwent
was not predictive for any of them. In a general approach, salvage surgery from a single institution. They found a
among patients with recurrence, those who had primary statistical significant better 5-year overall survival in favor
tumors stage I-II, those having recurred after 6 months of: (1) early (I/II) (43.6%) versus late recurrent clinical tumor,
of initial treatment and those being amenable to surgical node, and metastasis stages (III/IV) (29.1%), P = 0.027;
resection had better prognosis. (2) disease free interval more than 1 year (42.1%) versus
less than one year (26.7%), P = 0.023; and (3) previous
[4]
Kowalski et al., in a series of 513 patients with OSCC, treatment by surgery alone (39.3%) versus surgery followed
observed an overall recurrence rate of 41.7%, with 82 (16%) by RT (26.1%) or RT alone (25.3%), P = 0.028. There were
patients showing a regional recurrence. Only 36 (44%) no differences in relation to survival according to the
patients were amenable to salvage surgery, with an overall period of admission, sex, age, type of recurrence, and
survival after salvage surgery of 31% to 36%, depending status of surgical margins. Patients with recurrent cancer
on the location of the recurrence in the ipsi- or contra- of the oral cavity showed a higher 5-year overall survival
lateral neck. The authors found that patient’s previously rate than patients with recurrent oropharyngeal cancer
undergoing treatment of the neck experimented a poorer (33.6% vs. 25.6%), although this difference was not
Plast Aesthet Res || Volume 3 || June 24, 2016 191