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A Prospective Study

Jean Davidson, MD, FRCSC; David Briant, MD, FRCSC; Patrick Gullane, MB, FRCSC; Tom Keane, MB, FRCPC; Ellen Rawlinson, RTT

Arch Otolaryngol Head Neck Surg. 1994;120(3):269-276.

Abstract
Background
To comment on the use of surgery following radiotherapy failure for advanced laryngopharyngeal cancer.

Methods
Of 212 participants, 88 underwent potentially curative surgical salvage following radiotherapy failure. These 88 patients were followed up prospectively for a median of 4.4 years following surgery; complications, recurrences, tumor measures, and survival were documented to facilitate a critical analysis.

Results
Surgical complications developed in 48% of the patients, were most prevalent following pharyngectomy (P=.03), and were not influenced by the addition of a neck dissection (P=.76). Postsurgical survival was statistically associated with the TNM stage of the recurrent tumor and the site of recurrence (local or regional vs both), but was not associated with the TNM stage of the original tumor, time to recurrence, age, sex, or primary site. The overall 5-year postsurgical survival for this cohort was 35%. Utilizing a policy of primary radiotherapy, reserving surgery for radiotherapy failures, 41% of our patients retained functional larynges without reducing their overall survival.

Conclusions
We suggest that recurrent tumors be restaged, as the measures of the recurrent tumor, not the tumor at original presentation, correlate best with survival following surgical intervention for tumor recurrence.

(Arch Otolaryngol Head Neck Surg. 1994;120:269-276)

Author Affiliations
From the Departments of Otolaryngology, St Michaels Hospital (Drs Davidson and Briant) and Toronto (Ontario) Hospital (Dr Gullane), and the Department of Surgical Oncology, Division of Head and Neck Surgery (Drs Davidson, Briant, and Gullane), Department of Radiation Oncology (Dr Keane), and Clinical Trials Coordination Office (Ms Rawlinson), Princess Margaret Hospital, Toronto.

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