Salvage Surgery after Organ-Preservation - Simply Another Piece of the Puzzle

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Laura M. Fernandez ◽  
Nuno L. Figueiredo ◽  
Angelita Habr-Gama ◽  
Guilherme P. São Julião ◽  
Pedro Vieira ◽  
...  
Keyword(s):  
Organ Preservation ◽  
Salvage Surgery

scholarly journals Salvage Surgery in Head and Neck Cancer

2021 ◽  
pp. 233-246
Author(s):  
Stijn van Weert ◽  
Sat Parmar ◽  
C. René Leemans
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Organ Preservation ◽  
Salvage Surgery ◽  
Transoral Robotic Surgery ◽  
Shared Decision ◽  
Surgery Complications

AbstractSalvage surgery (SS) in head and neck cancer is considered a last resort treatment after failure of organ preservation treatments. It offers challenges to the patients and the surgeon. The outcome of SS is often uncertain in terms of survival and quality of life. This paper offers an overview of evolution in SS, tumor and patient factors to be considered, challenges in reconstructive surgery, complications of SS and the changing landscape with regard to increasing incidence of human papillomavirus positive tumours, the role of transoral robotic surgery, the importance of multidisciplinary management and shared decision making.

scholarly journals EP-1113: Salvage surgery after organ preservation treatment for head and neck cancer

2018 ◽  
Vol 127 ◽  
pp. S628-S629
Author(s):  
J.A. Dominguez Rullan ◽  
A. Hervás Morón ◽  
M.C. Vallejo Ocaña ◽  
M. Martín Martín ◽  
R. Morís ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Organ Preservation ◽  
Salvage Surgery

Single-Cycle Induction Chemotherapy Selects Patients With Advanced Laryngeal Cancer for Combined Chemoradiation: A New Treatment Paradigm

2006 ◽  
Vol 24 (4) ◽  
pp. 593-598 ◽  
Author(s):  
Susan Urba ◽  
Gregory Wolf ◽  
Avraham Eisbruch ◽  
Francis Worden ◽  
Julia Lee ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Induction Chemotherapy ◽  
Laryngeal Cancer ◽  
Organ Preservation ◽  
Residual Disease ◽  
Salvage Surgery ◽  
Survival Rates ◽  
Single Cycle ◽  
Larynx Preservation

Purpose Primary chemoradiotherapy in patients with advanced laryngeal cancer can achieve high rates of organ preservation without sacrificing survival compared with radiation alone or conventional laryngectomy. Appropriate selection of patients for organ preservation approaches could enhance overall treatment outcome and quality of life. We conducted a phase II organ preservation trial for patients with stage III and IV larynx cancer to determine whether late salvage surgery rates could be decreased and survival improved by selecting patients for organ preservation based on response to a single cycle of induction chemotherapy. Patients and Methods The chemotherapy was cisplatin 100 mg/m2 on day 1 and fluorouracil 1,000 mg/m2/d for 5 days. Patients who achieved less than 50% response had immediate laryngectomy. Patients who achieved more than 50% response went on to concurrent chemoradiotherapy. Histologic complete responders after chemoradiotherapy received two more cycles of chemotherapy. Patients with residual disease after chemoradiotherapy had planned salvage surgery. Results Of 97 eligible patients, 73 (75%) achieved more than 50% response and received chemoradiotherapy. A total of 29 patients (30%) had salvage surgery; 19 patients (20%) had early salvage surgery after the single cycle of induction chemotherapy, three patients (3%) had late salvage surgery after chemoradiotherapy, six patients (6%) eventually had salvage surgery for recurrence, and one patient had laryngectomy for chondroradionecrosis. The median follow-up time was 41.9 months. The overall survival rate at 3 years is 85%. The cause-specific survival rate was 87%. Larynx preservation was achieved in 69 patients (70%). Conclusion These results confirm excellent larynx preservation and improved overall survival rates compared with historical results.

Locally advanced resectable larynx (L) or oropharynx (OP) cancer: Updated results of organ preservation trial ECOG 2399

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5527-5527 ◽  
Author(s):  
A. J. Cmelak ◽  
S. Li ◽  
B. Murphy ◽  
B. Burkey ◽  
G. L. Adams ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Organ Preservation ◽  
Radiation Treatment ◽  
Salvage Surgery ◽  
Locally Advanced ◽  
Institutional Setting ◽  
Free Survival ◽  
Grade 5 ◽  
Epoetin Alpha ◽  
One Year

5527 Background: Taxane-based concurrent chemoradiation (CCR) for head and neck cancers has proven feasible and has a favorable toxicity profile compared to concurrent cisplatin and radiation. This phase II multi-institutional trial evaluates taxane-based induction chemotherapy followed by CCR for organ preservation in resectable Stage III/IV L and OP patients. Methods: Eligibility: Resectable stage T2N+, or T3-T4N0–3M0 biopsy-proven squamous Ca, age ≥18, PS 0–2, good organ function, and no prior chemotherapy or radiation. Treatment: induction paclitaxel (P) 175 mg/m2 and carboplatin (C) AUC 6 for 2 cycles q21d followed by concurrent P 30 mg/m2 q7d with 70 Gy if no evidence of progression. Weekly epoetin alpha 40kU was used if Hgb ≤15 (male) or ≤14 (female). The primary endpoint is organ preservation (freedom from salvage surgery with preserved speech and swallowing). Results: 105/111 pts (69 OP, 36 larynx) were eligible. Median FU is 33 months. No grade 5 toxicities occurred. 94% received full dose RT and 91% received ≥5 cycles of concurrent paclitaxel. At one year post-treatment, 13 (12%) patients required salvage surgery at the primary site (7-L, 6-OP), and 6 pts (6%) progressed and died (3-L, 3-OP). 1 pt (1%) died without progression and 85 pts (81%) are alive without progression (25-L, 60-OP). 12 pts (10%) have developed distant mets (6-L, 6-OP). 1-yr and 2-yr PFS for all pts is 77% and 64%. 12/69 OP and 9/36 L pts have died of disease. 1-yr event-free survival (EFS = no salvage surgery, recurrence or death) is 72% (77%-OP, 64%-L), and 2-yr EFS is 57% (68%-OP, 34%-L) (p = 0.02). 1-yr OS is 93%, 2-yr OS is 74% (OP vs. L p = 0.11). Conclusions: This regimen is well tolerated and is feasible in a multi-institutional setting. EFS with this regimen is lower than expected in larynx patients. The benefit of induction chemotherapy in this setting remains unproven but does not preclude CCR delivery. Funded, in part, by Bristol-Myers Squibb. [Table: see text]

A pilot study of modified neoadjuvant docetaxel/cisplatin/5-FU (TPF) to concomitant chemoradiotherapy (CT/RT) in locally advanced head and neck cancer (LAHNC): Preliminary results

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6039-6039
Author(s):  
D. Isla ◽  
J. Martínez-Trufero ◽  
S. Morales ◽  
A. Yubero ◽  
J. Lambea ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Organ Preservation ◽  
Salvage Surgery ◽  
Locally Advanced ◽  
Stage Iv ◽  
Preliminary Results ◽  
Conventional Fractionation ◽  
Highly Active ◽  
Total Treatment ◽  
Rate Evaluation

6039 Background: Sequential treatment with induction CT followed by CT/RT is highly active and under study in ongoing randomized trials. We started a pilot phase II trial to explore the efficacy, toxicity profile and organ preservation of a modified neoadjuvant TPF to concurrent CT/RT in both resectable (R) and unresectable (UR) LAHNC. Methods: One hundred seventy patients(p) with stage III-IV, PS ECOG 0–2, were included to receive 3 cycles of docetaxel 75 mg/m2 iv day(d) 1, cisplatin(P) 75 mg/m2 iv d2 and 5-FU 750 mg/m2 iv continuous infusion d2–5, every 3 weeks with prophylactic ciprofloxacin 500 mg twice daily from d6–15 of each cycle and granulocyte colony-stimulating factor as secondary or primary setting, followed by P 100 mg/m2 iv d1, 22, 43 concomitant with RT (66–70 Gy, conventional fractionation). Neck dissection was planned for p with stage N2–3 after induction CT or salvage surgery for resectable p with persistent disease at the end of treatment. Results: Main p characteristics were: median age 58 years (39–77), male 89%, ECOG 0/1/2 47%/50.6%/2.4%, stage IV 62.7%, larynx/hipopharynx/oral cavity/oropharynx 45%/12%/17.3%/25.7% and R/UR 41.8%/58.2%. Median TPF/P cycles administered were 3/3. Neoadjuvant CT/total treatment overall response rate evaluation (R/UR): 70% (73%/68%)/86% (84%/88%). Neck dissection was performed in 16 p and salvage surgery in 6 p. Organ preservation was achieved in 90.8% of R p. Main G3–4 toxicity during TPF treatment was neutropenia 11.2%, febrile neutropenia 11.2%, mucositis 11.2%, and during CT/RT mucositis 16.5%, neutropenia 16.5%. Median time to progression was 19.5 m(R:15.6, UR:20.3), and median overall survival was not reached (R:not reached, UR:32.8). Conclusions: Preliminary results indicate that modified neoadjuvant TPF followed by CT/RT is an active and well tolerated regimen in LAHNC, with satisfactory organ preservation and survival. No significant financial relationships to disclose.

Does non-TME surgery of rectal cancer compromise the chance of cure? Preliminary surgical salvage data from OPERA phase III randomized trial.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 12-12
Author(s):  
Arthur Sun Myint ◽  
Brice Thamphya ◽  
Jean-Pierre Gerard
Keyword(s):  
Rectal Cancer ◽  
Local Excision ◽  
Organ Preservation ◽  
Residual Disease ◽  
Salvage Surgery ◽  
Randomised Trial ◽  
Complete Response ◽  
Phase Iii ◽  
Residual Tumour ◽  
Surgical Salvage

12 Background: Non-operative modality (NOM) treatment of rectal cancer is gaining popularity as it avoids extirpative TME surgery and a stoma. OPERA trial was set up to evaluate the role of dose escalation using Contact X-ray brachytherapy [CXB] in improving the chance of organ preservation compared to the standard of care (EBCRT and TME surgery). We report on the preliminary surgical salvage data for treatment failures in the OPERA trial (NCT02505750). Methods: OPERA is a European phase 3 randomised trial between (Arm A- standard arm) EBCRT 45Gy/25/5weeks with oral capecitabine 825mg/m2 and EBRT boost of 9Gy/5/5 days randomised against (Arm B- experimental arm) EBCRT followed by CXB boost (90 Gy/3/4 weeks). Patients were assessed at 14, 20 and 24 weeks. Watch & wait policy was adopted for patients with cCR at 24 weeks after randomisation and surgery (TME or local excision) was offered for residual disease and also for local regrowth (recurrence) at a later date. Results: From July 2015 –June 2020, 148 patients were randomised of which 144 were evaluable (table). There were 71 patients in Arm A (standard) and 73 patients in Arm B (experimental). Median follow-up was 19 months (range 2-36 m). Overall clinical complete response (cCR) was observed in 103 out of 127 evaluable patients (81%) at 24 week in both arms (blinded). Surgery was carried out in 36/ 127 (28%) patients with suspected residual tumour. Further 13 patients had salvage surgery at a later date for local regrowth. At 19 months, 49/144 (34%) patients in total cohort had surgery. Local excision was carried out in 24 /49(49%) of which 3 proceeded to TME surgery due to R (1) or ypT2 adverse histology. TME surgery was carried out in 28/49 of which 8/28 (28.6%) had APER and 20/28(71.4%) had AR. In total, organ preservation (blinded) was achieved in 116/144 (80.5%) for the whole cohort. Kaplan Meier estimate of TME free survival is 76% at 19 months. Conclusions: Non-TME surgical treatment for cT2-cT3a-b rectal cancer is feasible in those who are fit and wish to avoid surgery (Watch & Wait). Those who needed surgery can be offered salvage surgery immediately for local residual disease or for local regrowth at a later date. Organ preservation of 80.5% (blinded) can be achieved without compromising their chance of cure. Clinical trial information: NCT02505750. [Table: see text]

Salvage Surgery With Organ Preservation for Patients With Local Regrowth After Watch and Wait: Is It Still Possible?

2020 ◽  
Vol 63 (8) ◽  
pp. 1053-1062
Author(s):  
Laura M. Fernandez ◽  
Nuno L. Figueiredo ◽  
Angelita Habr-Gama ◽  
Guilherme P. São Julião ◽  
Pedro Vieira ◽  
...  
Keyword(s):  
Organ Preservation ◽  
Salvage Surgery ◽  
Watch And Wait

Organ Preservation for Advanced Resectable Cancer of the Base of Tongue and Hypopharynx: A Southwest Oncology Group Trial

2005 ◽  
Vol 23 (1) ◽  
pp. 88-95 ◽  
Author(s):  
Susan G. Urba ◽  
James Moon ◽  
P.G. Shankar Giri ◽  
David J. Adelstein ◽  
Ehab Hanna ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Organ Preservation ◽  
Salvage Surgery ◽  
Hypopharyngeal Cancer ◽  
Primary Site ◽  
Oncology Group ◽  
Definitive Chemoradiotherapy ◽  
Primary Tumor Site ◽  
Southwest Oncology Group ◽  
Base Of Tongue

Purpose The Southwest Oncology Group designed a phase II trial for patients with base of tongue or hypopharyngeal cancer to evaluate the complete histologic response rate at the primary site after induction chemotherapy followed by chemoradiotherapy for responders. Secondary end points were the rate of organ preservation and the need for salvage surgery. Patients and Methods Fifty-nine eligible patients were enrolled; 37 had base of tongue cancer, and 22 had hypopharynx cancer. Forty-two percent had stage III disease, and 58% had stage IV disease. Induction chemotherapy was two cycles of cisplatin 100 mg/m2 and fluorouracil 1,000 mg/m2/d for 5 days. Patients who had a greater than 50% response at the primary site were treated with radiation 72Gy and concurrent cisplatin 100 mg/m2 for three cycles. Patients with less than partial response at the primary had immediate salvage surgery. Results Forty-five patients (76%) had a greater than 50% response at the primary after induction chemotherapy; 43 went on to receive definitive chemoradiotherapy. Thirty-two patients (54%) achieved a histologic complete response at the primary site, and an additional nine patients had a complete clinical response, but biopsy was not done. Seventy-five percent of patients did not require surgery at the primary tumor site. The 3-year overall survival was 64%. The 3-year progression-free survival with organ preservation was 52%. Conclusion Patients with base of tongue or hypopharyngeal cancer treated with this regimen of induction chemotherapy followed by definitive chemoradiotherapy have a good rate of organ preservation without compromise of survival.

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