Loco-regional recurrence of oral cavity squamous cell carcinoma (OCSCC) continues to be a life-threatening and difficult clinical situation. Salvage surgery can result in significant morbidities, and survival following recurrence is generally poor. In this study from Ontario, Canada, prognostic factors influencing overall survival (OS) following salvage surgery for oral squamous cell carcinoma were determined in 59 patients with loco-regional recurrence.
The authors identified three prognostic groups in patients undergoing salvage surgery for recurrent oral squamous cell carcinoma: 1) High risk patients who received adjuvant chemoradiotherapy or radiotherapy after initial surgery with five-year OS rate of only 10%; 2) Intermediate risk patients who had previous surgery alone, age ≥ 62 years with a five-year OS rate of 39%; 3) Low risk patients who had previous surgery alone, age < 62 years with five-year OS rate of 74%.
Salvage surgery for recurrent OCSCC may result in significant morbidity. Selecting patients appropriate for surgical salvage can be challenging because the presentation of the disease is variable and consideration of pre-existing comorbidities, prior treatments and patient goals can result in complexities in decision making. Patient stratification into risk categories may be of value when counselling patients with recurrent OCSCC and determining individualised treatment. In high risk patients, salvage surgery should be undertaken after careful consideration of the potential surgical morbidity and a realistic chance of long-term disease control.
