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Decision making in the management of recurrent head and neck cancer
Author(s) -
Ho Allen S.,
Kraus Dennis H.,
Ganly Ian,
Lee Nancy Y.,
Shah Jatin P.,
Morris Luc G. T.
Publication year - 2014
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.23227
Subject(s) - medicine , head and neck squamous cell carcinoma , salvage therapy , quality of life (healthcare) , head and neck cancer , disease , surgery , head and neck , intensive care medicine , oncology , cancer , chemotherapy , nursing
Despite substantial improvements in head and neck squamous cell carcinoma (HNSCC) treatment, the major obstacle to long‐term survival remains disease recurrence. Salvage options are often limited due to prior therapy and the escalated morbidity of retreatment. The costs of treatment must be measured against the anticipated quality and quantity of life recovered, even with resectable disease. This review surveys the recurrent HNSCC literature to better guide decision making. Across multiple studies, negative prognostic factors include impaired performance status, advanced recurrent stage, brief disease‐free interval, previous chemotherapy, and nonlaryngeal sites of recurrence. When possible, surgical salvage remains the principal option for durable disease control, quality of life preservation, and cure. Nonsurgical therapies have also demonstrated measurable improvements in locoregional control. Interpretation of salvage literature must be tempered by recognition of significant selection bias. The decision for salvage therapy must be individualized, with management that involves well‐informed patients resulting in the best outcomes. © 2013 Wiley Periodicals, Inc. Head Neck 36 : 144–151, 2014