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the use of only palliative treatment in recurrent oral resectability criteria allows for it, as 5-year OS is higher
cancer, mainly in advanced cancer previously treated than 30%. In the light of the results from the present
with surgery and radiotherapy, actually a main role for meta-analysis, with a mean 5-year OS rate upper than 40%,
curative treatment is advocated, basically by means of if candidates, salvage surgery is strongly recommended
salvage surgery. In a meta-analysis by Goodwin et al., [16] for treating recurrent OSCC patients.
a 5-year overall survival rate of 43% was reported for
[8]
recurrent SCC of the oral cavity, while a 26% was referred In concordance with several other studies, Liao et al. found
for recurrent SCC of the oropharynx. In the study by that better prognosis was achieved for local recurrence in
[5]
Agra et al. the overall 5-year survival rate was 32.3%, comparison to cervical recurrence. In concordance with it,
[9]
with a 33.6% for the SCC of the oral cavity and a 25.6% Lim and Choi also observed that although good salvage
for SCC of the oropharynx. Even, for advanced clinical was accomplished in local recurrences, a poor salvage
stage recurrences (rCS III/IV), an overall 29.1% 5-year rate was found in cases of cervical nodal recurrences,
[17]
overall survival was found. Zafereo et al. found a especially if being associated with a neck level IV
[13]
3-year and 5-year OS rates for salvage surgery of 42% recurrence. Goto et al. was coincident in asseverating
and 28%, respectively, being favorable patients for such that node involvement at levels IV or V was predictive for
a treatment: (1) youngers; (2) long disease-free interval a decreased 5-year OS rate.
after primary treatment; (3) small recurrent tumors for
which is possible to obtain negative surgical margins; and Besides several prognostic tumor-related factors, the
(4) no recurrent neck disease. All these OS rates illustrate influence of primary treatment modality in the outcome
that, even for advance recurrent OSCC, salvage surgery is of recurrent OSCC patients has also been investigated. In
[7]
still an option with curative intention for many patients. relation to this, the study by Brown et al. demonstrated
that the administration of postoperative RT negatively
Prognostic factors for survival are not similarly considered influenced prognosis and recurrence rate in patients
[3]
in all the studies. While some authors did not find a at intermediate risk of recurrence that underwent
relation between the clinical stage of the recurrence and further salvage surgery because of relapse. Goto et al. [13]
survival, others have encountered a significant association also demonstrated several prognostic factors being
[5]
among them. Agra et al. showed this association in predictive for a worse 5-year OS after salvage surgery,
the univariate as well as in the multivariate analysis. such as advanced stages (III and IV) recurrent tumors,
[16]
Goodwin et al. found that the clinical stage of the two or more positive cervical lymph nodes, positive
recurrent tumor was the most significant predictor of cervical lymph nodes at levels IV or V, ECS, and disease-
[13]
survival. Interestingly other authors have found the ECS free interval form primary treatment minor than a year.
as the most powerful prognostic factor for surveillance,
even superior to the stage of the recurrence. The role of salvage surgery
Traditionally, in relation to resectability criteria, many
Also, recurrences before 1 year after primary treatment concerns about the possibility for real resection of
seem to have worse prognosis. This is somehow a recurrent oral SCC and related reconstructive options
[8]
common topic, as Liao et al., in their series of 272 made salvage surgery scarcely indicated. Nowadays,
recurrent OSCC, have also checked that early recurrences advances in surgical approaches, technology,
before 10 months after primary treatment had a microsurgical reconstruction, and also surgeons´ training
significant worse prognosis in terms of 5-year DSS and have extended indications for salvage surgery, even for
[17]
OS than late-relapsed OSCC. Similarly, Zafereo et al., patients with advanced recurrent clinical stages III/IV.
for recurrent SCC of the oropharynx, observed that a
[8]
disease-free interval after primary treatment was a critical As pointed out by Liao et al. salvage therapy is of
factor in predicting the success of salvage surgery. In benefit for patients with early-relapsed OSCC in terms
[5]
concordance, Agra et al. showed that patients recurring of both 5-year DSS and OS. Interestingly, these authors
less than a year before primary treatment had a significant could not find a significant difference for salvage
worse prognosis. surgery compared with salvage RCT, regardless of
whether patients have a local or a regional recurrence.
While some authors [3,15] have suggested that patients In contrast, the benefit of salvage surgery over salvage
with advanced III/IV recurrent tumors that have received RCT was clearly stated for patients with late-relapsed
previous surgery followed by RT, based on poor OSCC, in which recurrence appeared 10 months later
prognosis, should only receive palliative treatment, this than primary treatment. In relation to the benefit of
[17]
asseveration is no longer supported in the light of the salvage surgery, Zafereo et al. revealed that patients
results from the last decade. In fact, there are several who underwent salvage surgery had a significantly
[5]
studies which indicate from multivariate analyses that higher 3-year OS rate than patients who underwent non-
previous treatment is not a predictor of survival anymore, surgical treatments (excluding patients who received
and so advanced recurrent OSCC patients cannot be supportive care), such as re-irradiation or brachytherapy
excluded from salvage surgery if general conditions and or chemotherapy.
Plast Aesthet Res || Volume 3 || June 24, 2016 193