Salvage Surgery with Intraoperative Electron Radiation Therapy for Recurrent or Persistent Head and Neck Cancer After Prior Radiotherapy
8 affiliations
- 1Department of Radiation Oncology, The James Cancer Hospital/Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
- 2Department of Radiation Oncology, El-Demerdash Hospitals, Ain Shams University, Cairo 11566, Egypt
- 3Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA 30322, USA
- 4Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- 5Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital/Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
- 6Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA 98195, USA
- 7Department of Medical Oncology, The James Cancer Hospital/Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
- 8Adjunct Faculty of Medicine, University of Prishtina, St. George Bush, No. 31, 10000 Prishtina, Kosovo
Abstract
Background/Objectives: Locoregionally recurrent or persistent head and neck cancer (rpHNC) after prior radiotherapy carries a poor prognosis, and optimal salvage strategies remain uncertain. We evaluated survival, patterns of failure, and 90-day postoperative complications after salvage surgery combined with intraoperative electron radiation therapy (IOERT). Methods: We retrospectively identified 127 previously irradiated patients treated with salvage surgery and IOERT between 1999 and 2023. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method, and locoregional failure (LRF) and distant failure were estimated using Aalen–Johansen cumulative incidence with death as a competing event. Associations were evaluated one predictor at a time in age- and sex-adjusted Cox (OS, DFS) and Fine-Gray (LRF) models without multiplicity adjustment, and they are exploratory. Results: With a median follow-up of 70 months, median overall survival (OS) was 20.5 months (95% CI, 14.6–40.2), with 1-, 2-, and 3-year OS rates of 63%, 48%, and 43%, respectively. Median disease-free survival (DFS) was 8.8 months. Positive surgical margins and extranodal extension (ENE) were associated with worse OS in separate age- and sex-adjusted models. The 1-, 2-, and 3-year cumulative incidences of LRF were 34.3%, 44.7%, and 49.8%, respectively. The corresponding cumulative incidences of distant failure were 21.6%, 24.0%, and 26.7%, respectively. Thirty-seven patients had a documented distant failure, of whom 27 (73%) experienced distant failure within one year. Available records documented three deaths within 90 days (3/127, 2.4%). Conclusions: Among rpHNC patients treated with this IOERT-containing multimodality salvage strategy, median OS was 20.5 months. Because the study lacked a salvage-surgery-only comparator, postoperative treatments were selectively administered, and complication reporting was incomplete, neither the efficacy nor the comparative safety of IOERT can be determined from these data.
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BibTeX
@article{elguindy2026salvage,
title = {{Salvage Surgery with Intraoperative Electron Radiation Therapy for Recurrent or Persistent Head and Neck Cancer After Prior Radiotherapy}},
author = {Ahmed N. Elguindy and Sujith Baliga and Brett G. Klamer and Allison Palmiero and Khaled N. Dibs and Andrew Koempel and Emile Gogineni and David Konieczkowski and Darrion L. Mitchell and Nolan Seim and Kyle VanKoevering and Catherine Haring and Lauren Miller and Stephen Y. Kang and Amit Agrawal and Enver Ozer and James W. Rocco and Ricardo L. Carrau and Matthew Old and Marcelo Bonomi and Priyanka Bhateja and Arnab Chakravarti and John Grecula and Dukagjin M. Blakaj},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18203399},
url = {https://www.mdpi.com/2072-6694/18/20/3399},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Salvage Surgery with Intraoperative Electron Radiation Therapy for Recurrent or Persistent Head and Neck Cancer After Prior Radiotherapy
AU - Ahmed N. Elguindy
AU - Sujith Baliga
AU - Brett G. Klamer
AU - Allison Palmiero
AU - Khaled N. Dibs
AU - Andrew Koempel
AU - Emile Gogineni
AU - David Konieczkowski
AU - Darrion L. Mitchell
AU - Nolan Seim
AU - Kyle VanKoevering
AU - Catherine Haring
AU - Lauren Miller
AU - Stephen Y. Kang
AU - Amit Agrawal
AU - Enver Ozer
AU - James W. Rocco
AU - Ricardo L. Carrau
AU - Matthew Old
AU - Marcelo Bonomi
AU - Priyanka Bhateja
AU - Arnab Chakravarti
AU - John Grecula
AU - Dukagjin M. Blakaj
PY - 2026
DA - 2026/10/01
JO - Cancers
DO - 10.3390/cancers18203399
UR - https://www.mdpi.com/2072-6694/18/20/3399
AB - Background/Objectives: Locoregionally recurrent or persistent head and neck cancer (rpHNC) after prior radiotherapy carries a poor prognosis, and optimal salvage strategies remain uncertain. We evaluated survival, patterns of failure, and 90-day postoperative complications after salvage surgery combined with intraoperative electron radiation therapy (IOERT). Methods: We retrospectively identified 127 previously irradiated patients treated with salvage surgery and IOERT between 1999 and 2023. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method, and locoregional failure (LRF) and distant failure were estimated using Aalen–Johansen cumulative incidence with death as a competing event. Associations were evaluated one predictor at a time in age- and sex-adjusted Cox (OS, DFS) and Fine-Gray (LRF) models without multiplicity adjustment, and they are exploratory. Results: With a median follow-up of 70 months, median overall survival (OS) was 20.5 months (95% CI, 14.6–40.2), with 1-, 2-, and 3-year OS rates of 63%, 48%, and 43%, respectively. Median disease-free survival (DFS) was 8.8 months. Positive surgical margins and extranodal extension (ENE) were associated with worse OS in separate age- and sex-adjusted models. The 1-, 2-, and 3-year cumulative incidences of LRF were 34.3%, 44.7%, and 49.8%, respectively. The corresponding cumulative incidences of distant failure were 21.6%, 24.0%, and 26.7%, respectively. Thirty-seven patients had a documented distant failure, of whom 27 (73%) experienced distant failure within one year. Available records documented three deaths within 90 days (3/127, 2.4%). Conclusions: Among rpHNC patients treated with this IOERT-containing multimodality salvage strategy, median OS was 20.5 months. Because the study lacked a salvage-surgery-only comparator, postoperative treatments were selectively administered, and complication reporting was incomplete, neither the efficacy nor the comparative safety of IOERT can be determined from these data.
SN - 2072-6694
ER -