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[6]
statistically significant (P = 0.226). Similarly, Koo et al., between OS following salvage surgery and restaging after
in a series about 127 patients with OSCC observed a 28% recurrence or margin status following surgical salvage.
overall recurrence rate, with a 12% local recurrence, 13% Conversely, they demonstrated a significant association
regional recurrence, and 2% loco-regional. They reported between survival and time to recurrence, showing that
a 5-year overall survival rate of 38% and the mean interval recurrences within the first 6 months from the primary
free of disease higher taller than in 18%. treatment had a worse prognosis.

[7]
[13]
In a well-known study by Brown et al. about a series of According to Goto et al., in a series of 69 recurrent
462 patients with OSCC treated by surgery followed or OSCC, the 5-year OS rate for those patients undergoing
not by postoperative RT, they found an overall recurrence salvage surgery ranged from 86% in recurrent stage I or
rate of 21%, with a 10.4%, 7.35% and 3.46% of local, II to 48% in recurrent stage III or IV. Their multivariate
regional and loco-regional recurrence rates, respectively. analysis identified extra-capsular spread (ECS) as an
They wanted to study the hypothetic benefit of post- independent prognostic factor for OS following salvage
operative RT in the group of patients at intermediate surgery, with patients presenting ECS at salvage surgery
risk of recurrence, and observed that a significant higher having a 37% 5-year OS rate, in contrast to 78% for those
proportion of patients undergoing adjuvant RT had loco- do not presenting ECS.
regional recurrence (24%) compared to those treated by
surgery alone (15%). They also found an improved salvage Overall results from the systematic
rate for recurrent disease in the surgery alone group (53%) review
in comparison to the postoperative RT group (13%).
Several articles in the primary literature search evaluated
recurrence and overall survival rates in relation to “head and
[8]
Liao et al., in a series of 272 recurrent OSCC patients, neck cancer” or “squamous cell carcinoma” of the “upper
found an overall recurrence rate of 28.5%, with a local aerodigestive tract”, including oral cavity, oropharynx,
recurrence of 48.9% and a regional recurrence of 51.1%. hypopharynx and larynx subsites. As categorization was
They observed that the cutoff point at 10 months from not always performed by the authors and results specifically
the initial treatment has the worst prognosis in terms of
5-year disease-specific survival (DSS) and overall survival dealing with OSCC were not either supported, these series
(OS). They found that a late-relapse was associated were systematically excluded from our study. Thus, only
with better survival than an early-relapse occurring those series specifically dealing with recurrence and overall
within the first 10 months after primary treatment. survival at the oral cavity and/or oropharynx were selected
Considering treatment in patients with early-relapsed and included for the analysis [Table 1].
OSCC, a significant benefit was demonstrated for salvage
treatment (salvage surgery with or without RCT), in terms From the finally analyzed 13 articles, a recalculation of the
of both 5-year DSS and OS. Similarly, in patients with values within selected variables was performed. For their
a late-recurrence OSCC, a significant improvement in calculation, only those articles with available data in relation
to a specific variable were selectively chosen. A total number
both 5-year DSS and OS rates were observed for salvage of 1,692 patients with recurrent OSCC were included
therapy. It is interesting to note that salvage surgery was
significantly better than salvage RCT for patients with from the author’s selection, ranging from 16 patients
late-relapsed OSSC but not for early-relapsed OSCC. corresponding to the lower series to 434 patients from the
largest one. The recalculated overall recurrence rate from
[9]
In 2008, Lim and Choi found recurrences of OSCC to the meta-analysis was 26% (range: 15-41.7%), with a mean
appear in 21% of the patients with T1 and T2 tumors 47.3%, 35.1% and 10.9% of local, regional and loco-regional
primarily treated with surgery alone, with 31% and recurrences, respectively.
50% local and regional recurrences rates, respectively.
They encountered a 36% OS rate for recurrent patients Except for a single paper, the 5-year OS rate was present
following salvage surgery. This recurrent rate is very in all selected papers. Regarding the survival expressed in
[7]
similar to that reported by Brown et al. and also by terms of 5-year OS rate, a mean value of 40.2% (range: 37.5-
Kernohan et al. [10] with a 22% recurrence rate. These 42.9%) was obtained from the meta-analysis. Three particular
authors also reported a quite high OS of 50% for series showed their results concerning survival in terms of
recurrent patients. Meanwhile, in a short series by categorization upon early stage (I/II) or advanced stage (III/
Sklenicka et al., in 2010, they found a 15% recurrence IV), and thus two values for the variable 5-year OS rate were
[11]
rate, with 67% of recurrent patients undergoing further provided. This could explain the observed range of survival
salvage surgery and an estimated 5-year disease-free rates between 37.5% and 42.9%.
survival of 48% for the whole series.
DISCUSSION
[12]
Kostrzewa et al., in a series of 72 recurrent OSCC patients
that underwent salvage surgery, observed a 44% OS rate. Survival of recurrent OSCC patients
These authors did not encounter a significant association Although some classical studies [14,15] advocated for
192 Plast Aesthet Res || Volume 3 || June 24, 2016