Browsing by Subject "SURGICAL SALVAGE"

Sort by: Order: Results:

Now showing items 1-2 of 2
  • Leea, Anne W. M.; Ng, Wai Tong; Chan, Jimmy Y. W.; Corry, June; Mäkitie, Antti; Mendenhall, William M.; Rinaldo, Alessandra; Rodrigo, Juan P.; Saba, Nabil F.; Strojan, Primoz; Suarez, Carlos; Vermorken, Jan B.; Yom, Sue S.; Ferlito, Alfio (2019)
    As a consequence of the current excellent loco-regional control rates attained using the generally accepted treatment paradigms involving intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC), only 10-20% of patients will suffer from local and/or nodal recurrence after primary treatment. Early detection of recurrence is important as localized recurrent disease is still potentially salvageable, but this treatment often incurs a high risk of major toxicities. Due to the possibility of radio-resistance of tumors which persist or recur despite adequate prior irradiation and the limited tolerance of adjacent normal tissues to sustain further additional treatment, the management of local failures remains one of the greatest challenges in this disease. Both surgical approaches for radical resection and specialized re-irradiation modalities have been explored. Unfortunately, available data are based on retrospective studies, and the majority of them are based on a small number of patients or relatively short follow-up. In this article, we will review the different salvage treatment options and associated prognostic factors for each of them. We will also propose a treatment algorithm based on the latest available evidence and discuss the future directions of treatment for locally recurrent NPC.
  • Bossi, Paolo; Alfieri, Salvatore; Strojan, Primoz; Takes, Robert P.; Lopez, Fernando; Mäkitie, Antti; Saba, Nabil F.; Pablo Rodrigo, Juan; Bradford, Carol; Suarez, Carlos; Zafereo, Mark; Forastiere, Arlene A.; Vermorken, Jan B.; Quer, Miquel; Sanabria, Alvaro; Simo, Ricard; de Bree, Remco; Rinaldo, Alessandra; Ferlito, Alfio (2019)
    The pattern of clinical behaviour and response to treatment of recurrent and/or metastatic head and neck squamous cell carcinoma is heterogeneous. Treatment strategies that can be employed vary from potentially curative salvage surgery and re-irradiation to palliative systemic therapies and best supportive care. The advent of new therapeutic options, in terms of more sophisticated surgical approaches and techniques, highly conformal and precise radiation techniques and immunotherapy may offer improved control of disease and longer survival. Moreover, the epidemiological changes during the last decades, including the increase of human papilloma virus-related oropharyngeal primary tumors, are also reflected in the recurrent and metastatic setting. In this complex context the identification of predictive and prognostic factors is urgently needed to tailor treatment, to increase its efficacy, and to avoid unnecessary toxicities. A better knowledge of prognosis may also help the patients and caregivers in decision making on the optimal choice of care. The purpose of our review is to highlight the current evidence and shortcomings in this field.