PRACTICE GUIDELINES
AHNS series: Do you know your guidelines? Guideline recommendations for recurrent and persistent head and neck cancer after primary treatment
Ryan McSpadden MD,
Chad Zender MD,
Antoine Eskander MD, ScM, FRCS(C),
Ryan McSpadden MD
Department of Head & Neck, Plastic and Reconstructive Surgery - Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
Search for more papers by this authorChad Zender MD
Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, University Hospital Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
Search for more papers by this authorCorresponding Author
Antoine Eskander MD, ScM, FRCS(C)
Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, University of Toronto, Sunnybrook Health Sciences and the Odette Cancer Centre, Michael Garron Hospital, Toronto, Ontario, Canada
Correspondence
Antoine Eskander, MD, ScM, FRCSC, Department of Otolaryngology – Head & Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, 2075 Bayview Ave., M1-102, Toronto, ON, Canada M4N 3M5.
Email: [email protected]
Search for more papers by this authorRyan McSpadden MD,
Chad Zender MD,
Antoine Eskander MD, ScM, FRCS(C),
Ryan McSpadden MD
Department of Head & Neck, Plastic and Reconstructive Surgery - Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
Search for more papers by this authorChad Zender MD
Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, University Hospital Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
Search for more papers by this authorCorresponding Author
Antoine Eskander MD, ScM, FRCS(C)
Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, University of Toronto, Sunnybrook Health Sciences and the Odette Cancer Centre, Michael Garron Hospital, Toronto, Ontario, Canada
Correspondence
Antoine Eskander, MD, ScM, FRCSC, Department of Otolaryngology – Head & Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, 2075 Bayview Ave., M1-102, Toronto, ON, Canada M4N 3M5.
Email: [email protected]
Search for more papers by this authorAbstract
Locoregional recurrent/persistent head and neck cancer following primary treatment is a significant challenge as it is usually difficult to treat and has worse outcomes compared to the primary setting. Surgical resection of a local or regional recurrence offers the best chance of cure when feasible. Local recurrence outcomes vary by subsite with laryngeal recurrences having the best prognoses and hypopharynx having the worst. Instances of persistent neck masses following primary nonsurgical treatment can be evaluated with positron emission tomography (PET) with CT (PET-CT) when there is no definitive diagnosis of a recurrence/persistence. Reirradiation with or without chemotherapy can be considered for primary treatment when surgery is not an option, for adjuvant treatment following salvage surgery, or for palliation. Immunotherapy represents a newer class of chemotherapeutic agents. Current guidelines recommend enrollment in clinical trials especially when surgery is not an option as outcomes remain universally poor in the recurrent/persistent setting.
CONFLICT OF INTEREST
None.
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