Salvage treatment for recurrent squamous cell carcinoma of the oral cavity

Background. Squamous cell carcinoma (SCCA) of the oral cavity recurs with a frequency of 25%-48%, a fact that usually portends a poor prognosis. Recen t studies have reported salvage cure rates as high as 67%. Investigators ha ve also claimed that restaging recurrent tumors provides useful prognostic information, although this has not been demonstrated with tumors of the ora l cavity. The purposes of this study were: (1) to report the patterns of re current SCCA of the oral cavity; (2) to examine the benefit of restaging or al cavity tumors, and (3) to compare different treatment modalities in the management of recurrent SCCA of the oral cavity. Materials and Methods. Thirty-eight patients who developed recurrent SCCA o f the oral cavity were reviewed. Salvage treatment consisted of surgery, ch emotherapy, radiation therapy, or a combination of these modalities. Surviv al analysis was based on the stage of the primary and recurrent tumors and the type of salvage treatment received. Results. The overall recurrence rate was 28%. Local recurrence was most com mon (58%) followed by locoregional (27%) and regional recurrence (16%). Pat ients who recurred more than 6 months after completion of their primary tre atment had improved survival compared with those who recurred within 6 mont hs of initial treatment. Individuals with stage I-II primary tumors had sig nificantly improved salvage time and total survival time compared with thos e with stage Ill-IV primary tumors (p < 0.005 and p < 0.001). Conversely, t he stage of the recurrent tumor was not predictive of either improved salva ge time or total survival time. Patients who underwent salvage surgery had significantly improved salvage time and total survival time compared with t hose who received chemotherapy and/or radiation therapy (p < 0.001 and p < 0.002). The overall salvage cure rate was 21%. Neither the stage of the pri mary or recurrent tumors nor the type of salvage treatment received signifi cantly correlated with an improved cure rate. However, the group of patient s who underwent salvage surgery approached a statistically significant impr ovement in cure rate (p = 0.08). Conclusions. Squamous cell carcinoma of the oral cavity is most likely to r ecur at the primary site. The stage of the primary tumor is significantly c orrelated with survival even after recurrence, but the stage of the recurre nt tumor is not significantly correlated with survival. Patients most likel y to benefit from retreatment are those who (1) have primary tumors stage I -II, (2) recur greater than 6 months after their initial treatment, and (3) develop recurrences that are amenable to salvage surgery. (C) 2000 John Wi ley & Sons, Inc.