THE ROLE OF SURGERY FOLLOWING RADIOTHERAPY FAILURE FOR ADVANCED LARYNGOPHARYNGEAL CANCER - A PROSPECTIVE-STUDY

Background: To comment on the use of surgery following radiotherapy fa ilure for advanced laryngopharyngeal cancer. Methods: Of 212 participa nts, 88 underwent potentially curative surgical salvage following radi otherapy 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 pati ents, were most prevalent following pharyngectomy (P=.03), and were no t influenced by the addition of a neck dissection (P=.76). Postsurgica l survival was statistically associated with the TNM stage of the recu rrent tumor and the site of recurrence (local or regional vs both), bu t was not associated with the TNM stage of the original tumor, time to recurrence, age, sex, or primary site. The overall 5-year postsurgica l survival for this cohort was 35%. Utilizing a policy of primary radi otherapy, reserving surgery for radiotherapy failures, 41% of our pati ents retained functional larynges without reducing their overall survi val. Conclusions: We suggest that recurrent tumors be restaged, as the measures of the recurrent tumor, not the tumor at original presentati on, correlate best with survival following surgical intervention for t umor recurrence.