Patterns of Regional Recurrence and Salvage Treatment in Patients With Oral Cancer

Objectives Regional failure after primary treatment for oral squamous cell carcinoma (OSCC) carries a dismal outcome. Our goal was to investigate the recurrence patterns and salvage treatment in patients with OSCC and regional failure. Study design Retrospective chart review of all patients treated for OSCC in a university-affiliated tertiary care center during 2000-2018. Methods Data collected from patients' medical charts included demographics, clinical and pathological features, staging, treatment modalities and outcomes. Patients with insufficient data or a follow-up of less than 2 years were excluded. Results Out of 266 surgically treated patients, 55 developed regional recurrence and were included in the study cohort. Forty patients received surgical salvage treatment followed by adjuvant chemo-radiotherapy (CRT). Disease specific survival and overall survival were significantly higher in surgically treated patients compared to patients who received non-surgical treatment (46.7% vs. 0%, log-rank P value < .001 and 35.3% vs. 0%, log-rank P value = .001, respectively) and in patients who recurred regionally more than 10 months following initial treatment (40.8% vs 10.7%, log-rank P value = .065). Patients with early recurrence were older (73.6 vs. 61.3 years) and had a deeper invasion of the primary tumor (10.1 vs. 7 mm). Conclusions Salvage neck dissection is feasible in most cases, providing the best outcomes in patients with OSCC who fail regionally. Close follow-up during the first year after initial treatment is paramount as early recurrence carries a dismal prognosis. Specifically, elderly patients and patients with deeper primary tumor invasion should be closely monitored during the first post-operative year. Level of Evidence 4 Laryngoscope, 2021