Management of advanced recurrent oral squamous cell carcinoma: Is still salvage surgery indicated?

Abstract

Introduction: Locorregional recurrent disease (LRD) represents the most common cause of mortality in patients with oral squamous cell carcinoma (OSCC). Salvage surgery has been reported as the primary option for these patients. However, some groups have proposed it may be considered as therapeutic obstinacy, specially in advanced stages. This study wants to determine if salvage surgery is the most suitable treatment for LRD in advanced OSCC. Patients and methods: A retrospective cohorts study was designed including patients diagnosed with recurrent OSCC between May 2012 and December 2015 (n = 32). Patients were divided in two groups depending on whether salvage surgery was performed or not. Patients were followed-up for five years. Results: No differences were found between both groups according to sex, age, Charlson comorbidity index, initial TNM, stage, localization and treatment, recurrent TNM, stage and localization or time until recurrence. Statistically significant differences (p < 0.001) were found in disease free survival and overall survival between both groups, even when stratified in early and advanced stages. Discussion and conclusion: According to our results, salvage surgery provides both disease free survival and overall survival to patients with recurrent oral scamous cell carcinoma, even in advanced stages. However, it is true that salvage surgery is very likely to produce important comorbidities. We consider that these results should be explained to the patient in a comprehensive and compassionate talk and he or she should decide whether to go through this process or not.