Results of salvage treatment of the neck in patients with oral cancer

Background: About 50% of the patients with neck recurrences after the treatment of oral squamous cell carcinoma are not considered candidates for further treatment, and reported survival is generally poor. Objective: To evaluate the prognostic importance of neck recurrences and results of salvage treatment in patients with oral carcinoma. Patients: Five hundred thirteen patients with squamous cell carcinoma of the oral cavity underwent surgical treatment, with follow-up from less than 2 to 119 months (mean, 16.9 months). Setting: Referral center, private or institutional practice, and ambulatory and hospital care center. Intervention: Four hundred forty-eight patients underwent neck dissection, and 65, resection of the primary tumor only. Postoperative radiotherapy was used for 228. Main Outcome Measures: Rates of neck recurrences and survival after salvage treatment. Results: Eighty-two patients (16.0%) had neck recurrences, including ipsilateral in 44, contralateral in 3 1, and bilateral in 7. Most neck recurrences (77 [94%]) were diagnosed within 2 years. Salvage treatment was attempted in 51 patients (62%). Of the patients with a previously untreated side of the neck, 27 underwent radical neck dissections (11 ipsilateral and 16 contralateral) and only 5 remained with no evidence of disease. The significant factors associated with survival after neck recurrence were type of previous neck dissection (P<.001), previous postoperative radiotherapy (P=.003), and interval free of neck recurrence (P<.001). Conclusions: Patients undergoing previous neck dissection and with recurrences diagnosed after 6 months are not usually candidates for curative salvage treatment and are at a high risk for death. Only 5 of 46 patients with recurrences in a previously untreated side of the neck survived after salvage treatment. Patients with neck recurrences have a poor prognosis, despite salvage treatment.