European Journal of Surgical Oncology

Whether salvage surgery after chemoradiation in recurrent or residual head and neck cancer improves outcomes is an open question. The proponents of salvage surgery point to the multiple small, retrospective, single-center analyses performed across the globe which hint towards the efficacy of salvage surgery. The opponents on the other hand point that diseases with small volumes that are accessible without involving critical structures are usually selected for salvage surgery. This selection gives a biological advantage to patients undergoing salvage surgery over those treated with non-surgical modalities and therefore it is possible that the improved outcomes seen with salvage surgery are a result of selection bias. To answer this question we performed this analysis. This was a post hoc analysis of data from a phase 3 study comparing the efficacy of cisplatin - radiation versus Nimotuzumab-cisplatin-radiation. Patients in this study who had the recurrent or residual disease and who were eligible for salvage surgery were selected for this study. These were divided into 2 cohorts for comparison, willing for salvage surgery (n=91) and unwilling for salvage surgery(n=22). The primary endpoint was overall survival. This we thought was a better method of comparison than who underwent salvage surgery versus did not undergo salvage surgery. As some patients even who are willing for salvage surgery progress before the surgery. This biologically bad subgroup deteriorates the results of patients who did not undergo salvage surgery group. We feel this analysis is close to perfect as performing a randomized study in this setting seems unethical after observing our results. The results are in favor of salvage surgery.

The use of systemic chemotherapy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in appendiceal carcinomatosis is not associated with better clinical outcomes. Traditional agents may not be effective and other regimens are needed.

Local Recurrence (LR) rates - LR was defined as any form of pelvic relapse after effective surgery for the primary tumor; Distant Disease (DD) rates - DD was established as any form of distant disease dissemination); and Overall Survival (OS) - was defined as death from any cause)

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