Perception of survival/laryngeal preservation trade-off in advanced T-stage laryngeal cancer.

OBJECTIVES: To evaluate the perception of the survival/laryngeal preservation trade-off in advanced T-stage laryngeal cancer. MATERIAL AND METHODS: The Cochrane, PubMed, Embase, and Science Direct databases were searched using the keywords "cancer, neoplasms, trade-off. One hundred and eighty four articles were found; 176 of these, without data in the Abstract documenting the survival/laryngeal preservation trade-off for advanced T-stage laryngeal cancer, were excluded. Eight articles, totaling 1,052 interviewees, were read to document modalities of evaluation, trade-off thresholds, and variables influencing the perception of trade-off. RESULTS: Evaluation of trade-off was based on responses in group discussions, interviews and questionnaires and on patient file analysis. One study reported that 28.2% of respondents could not make a decision between options, and in 4 studies 22% to 80% of respondents would not consider jeopardizing survival. A mean 2-3 year gain (range, 6 months to 5 years) in survival was required before preferring total laryngectomy to chemoradiotherapy. The percentage loss of disease-free survival tolerated by respondents who would consider a trade-off to preserve the larynx ranged from 5% to 100%, for a median 30%. Variables influencing trade-off comprised respondent status (patient/healthcare provider/healthy subject) and characteristics (job, having children) and treatment data (amount and modalities of information delivered, survival estimates after radiation therapy, health status after treatment). A time for reflection after diagnosis and good quality information were important for respondents. CONCLUSION: Several consequences emerge from these data. The first is to consider induction chemotherapy, to give the patient time to make an informed choice. The second is to not to give up teaching total laryngectomy The third is to determine whether the team's own results match the information delivered to patients.

Pharyngocutaneous fistula in irradiated patients: systematic review and our experience.

OBJECTIVE: Radiotherapy is considered a risk factor for pharyngocutaneous fistula after a total laryngectomy. This study aimed to analyse the impact of exclusive radiotherapy versus chemoradiotherapy and the time interval between radiotherapy and surgery on the risk of pharyngocutaneous fistula. METHOD: This study was a retrospective revision of 171 patients treated with a total laryngectomy after radiotherapy or chemoradiotherapy. RESULTS: Pharyngocutaneous fistula occurred in 33 patients (19.3 per cent). Patients previously treated with chemoradiotherapy showed a non-significant higher pharyngocutaneous fistula rate compared with patients treated with radiotherapy (25.0 per cent vs 18.0 per cent; p = 0.455). Patients with a pharyngocutaneous fistula after chemoradiotherapy treatment required a surgical repair more frequently than patients treated with radiotherapy (p = 0.005). There were no significant differences in the pharyngocutaneous fistula rate depending on the time interval between radiotherapy and surgery (p = 0.580). CONCLUSION: There were no differences in the pharyngocutaneous fistula rate after total laryngectomy depending on the previous treatment with radiotherapy or chemoradiotherapy, or depending on the interval between radiotherapy treatment and surgery.

Predictive value of transcriptional expression of Krüppel-like factor-6 (KLF6) in head and neck carcinoma patients treated with radiotherapy

Purpose To analyse the relationship between the transcriptional expression of Krüppel-like factor-6 (KLF6) and local response to treatment with radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC). Methods We determined the transcriptional expression of KLF6 in tumour biopsies obtained before treatment with radiotherapy in 83 HNSCC patients. The KLF6 expression was categorized according to the local control of the disease with a recursive partitioning analysis. Results During the follow-up period, 27 patients (32.5%) had a local recurrence of the tumour. Patients with local recurrence had significantly higher levels of KLF6 expression than patients in which radiotherapy achieved local control of the disease (P = 0.029). Five-year local recurrence-free survival for patients with a high transcriptional expression of KLF6 (n = 46) was 51.1% (95% CI 36.4–66.2%), and for patients with low expression it was 85.6% (95% CI 73.9–97.3%) (P = 0.0001). The results of a multivariate analysis showed that patients with a high KLF6 expression had a 3.8 times higher risk of local recurrence after treatment with radiotherapy (95% CI 1.4–10.5, P = 0.008). Conclusion Transcriptional expression of KLF6 was significantly related to local control in HNSCC patients treated with radiotherapy. Patients with high levels of KLF6 expression had a significantly higher risk of local recurrence after treatment (AU)

Predictive value of transcriptional expression of Krüppel-like factor-6 (KLF6) in head and neck carcinoma patients treated with radiotherapy.

PURPOSE: To analyse the relationship between the transcriptional expression of Krüppel-like factor-6 (KLF6) and local response to treatment with radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC). METHODS: We determined the transcriptional expression of KLF6 in tumour biopsies obtained before treatment with radiotherapy in 83 HNSCC patients. The KLF6 expression was categorized according to the local control of the disease with a recursive partitioning analysis. RESULTS: During the follow-up period, 27 patients (32.5%) had a local recurrence of the tumour. Patients with local recurrence had significantly higher levels of KLF6 expression than patients in which radiotherapy achieved local control of the disease (P = 0.029). Five-year local recurrence-free survival for patients with a high transcriptional expression of KLF6 (n = 46) was 51.1% (95% CI 36.4-66.2%), and for patients with low expression it was 85.6% (95% CI 73.9-97.3%) (P = 0.0001). The results of a multivariate analysis showed that patients with a high KLF6 expression had a 3.8 times higher risk of local recurrence after treatment with radiotherapy (95% CI 1.4-10.5, P = 0.008). CONCLUSION: Transcriptional expression of KLF6 was significantly related to local control in HNSCC patients treated with radiotherapy. Patients with high levels of KLF6 expression had a significantly higher risk of local recurrence after treatment.

Elective neck dissection during salvage surgery after radiotherapy in patients with head and neck squamous cell carcinoma.

SUMMARY: Elective neck dissection in patients with recurrent head and neck squamous cell carcinoma (HNSCC) without evidence of neck disease (crN0) is poorly defined. A retrospective review was carried out on 165 crN0 patients treated with salvage surgery and elective neck dissection. Multivariate Cox analysis and recursive partitioning analysis were used to evaluate prognostic factors. The frequency of occult neck node metastases in the neck dissection (rpN+) was 16.4%. The risk of occult metastases for glottic rpT1-T2 recurrences was 5.9%, for glottic rpT3-T4 recurrences 13.2%, for non-glottic rpT1-T2 recurrences 16.1% and for locally advanced (rpT3-T4) non-glottic recurrences 31.1%. Patients with occult neck node metastases (rpN+) had a 5-year adjusted survival rate of 38.1%, while patients without nodal disease (rpN0) had a 5-year adjusted survival rate of 71.1% (p = 0.0001). Elective neck dissection can be omitted in crN0 patients with rT1-T2 glottic recurrence. We consider it advisable to perform elective neck dissection in all other situations.

Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study.

BACKGROUND: Western multicenter studies on distal pancreatectomy with celiac axis resection (DP-CAR), also known as the Appleby procedure, for locally advanced pancreatic cancer are lacking. We aimed to study overall survival, morbidity, mortality and the impact of preoperative hepatic artery embolization (PHAE). METHODS: Retrospective cohort study within the European-African Hepato-Pancreato-Biliary-Association, on DP-CAR between 1-1-2000 and 6-1-2016. Primary endpoint was overall survival. Secondary endpoints were radicality (R0-resection), 90-day mortality, major morbidity, and pancreatic fistulae (grade B/C). RESULTS: We included 68 patients from 20 hospitals in 12 countries. Postoperatively, 53% of patients had R0-resection, 25% major morbidity, 21% an ISGPS grade B/C pancreatic fistula, and 16% mortality. In total, 82% received (neo-)adjuvant chemotherapy and median overall survival in 62 patients with pancreatic ductal adenocarcinoma patients was 18 months (CI 10-37). We observed no impact of PHAE on ischemic complications. CONCLUSIONS: DP-CAR combined with chemotherapy for locally advanced pancreatic cancer is associated with acceptable overall survival. The 90-day mortality is too high and should be reduced. Future studies should investigate to what extent increasing surgical volume or better patient selection can improve outcomes.

Correction to: Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study.

In the original article, the institutional author the E-AHPBA DP-CAR study group was misspelled. It is correct as reflected here. The original article has also been corrected.

Understanding the anatomy of the larynx from the era of Gimbernat to the present day moving towards laryngeal transplantation

Knowledge of the gross anatomy of the larynx in Spain throughout the period when Gimbernat was working as a surgeon and anatomist was considerable; very much comparable to our present understanding. However, the lack of aseptic surgical technique, anaesthesia, and antibiotics limited the ability to undertake complex surgery. Nevertheless, it was during that period when for first time it became possible to diagnose some laryngeal pathologies, thanks to the invention, by a Spanishsinger, Manuel Garcia (1805-1906), of a primitive laryngoscope that made it possible to see the laryngeal interior. Only in 1873 was the first major surgery of the larynx was reported when Billroth undertook the first laryngectomy to treat surgically laryngeal carcinoma. It was more than a hundred years later, before the first laryngeal transplantation was attempted by Strome and his team (1998), and though initially meeting with some success, that transplanted larynx had to be removed 14 years later. Based on our current understanding of laryngeal anatomy and surgical technique, we argue that there are four factors that must be addressed if satisfactory transplantation of the larynx to be achieved: 1) psycho-social and ethicolegal aspects; 2) tissue viability vs. rejection; 3) restoration of a vascular, and 4) selective reinnervation of the larynx has to be achieved. The three first factors are being addressed, however, the selective reinnervation remains challenging because the nerve supply of the larynx is now known to be much more complex than many accounts imply. This is because: 1) each laryngeal muscle may receive a variable number of nerve branches; 2) there are multiple connections between the different laryngeal nerves; 3) many laryngeal nerves and connections are mixed conveying both motor and sensory fibres; and 4) the laryngeal muscles may receive a dual nerve supply, from both the recurrent laryngeal and superior laryngeal nerves (AU)

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Classification of parotidectomies: a proposal of the European Salivary Gland Society.

The objective of this study is to provide a comprehensive classification system for parotidectomy operations. Data sources include Medline publications, author's experience, and consensus round table at the Third European Salivary Gland Society (ESGS) Meeting. The Medline database was searched with the term "parotidectomy" and "definition". The various definitions of parotidectomy procedures and parotid gland subdivisions extracted. Previous classification systems re-examined and a new classification proposed by a consensus. The ESGS proposes to subdivide the parotid parenchyma in five levels: I (lateral superior), II (lateral inferior), III (deep inferior), IV (deep superior), V (accessory). A new classification is proposed where the type of resection is divided into formal parotidectomy with facial nerve dissection and extracapsular dissection. Parotidectomies are further classified according to the levels removed, as well as the extra-parotid structures ablated. A new classification of parotidectomy procedures is proposed.

Novetats farmacològiques en pediatria a Espanya: any 2012 / No disponible

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Delayed carotid blow-out syndrome: a new complication of chemoradiotherapy treatment in pharyngolaryngeal carcinoma.

BACKGROUND: Carotid blow-out syndrome is one of the most devastating complications of head and neck carcinoma. It usually occurs as a post-operative complication or when the tumour compromises the vascular axis. METHODS AND RESULTS: We report two patients who suffered carotid blow-out syndrome but who did not have the usual predisposing factors. Both patients had a pharyngolaryngeal carcinoma that was treated with chemoradiotherapy. Residual non-tumoural ulceration was seen along the lateral wall of the hypopharynx in both cases. This ulceration eventually reached the vascular axis, precipitating carotid rupture and death. CONCLUSION: Residual non-tumoural ulceration of the lateral wall of the hypopharynx after chemoradiotherapy should be considered with the utmost caution. Once persistence of the tumour is excluded, surgery is indicated to protect the vascular axis, in order to prevent carotid blow-out syndrome.

Novetats farmacològiques en pediatria a Espanya: any 2011 / No disponible

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Gene expression signatures and molecular markers associated with clinical outcome in locally advanced head and neck carcinoma.

The purpose of this study was to identify molecular markers associated with tumor recurrence and survival in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). We studied the expression profile of 63 pre-treatment tumor biopsies obtained from locally advanced HNSCCs treated with standard treatments. Cluster analysis identified three tumor subtypes associated with significant differences in local recurrence-free survival (LRFS) (P<0.001), progression free-survival (PFS) (P<0.009) and overall survival (OS) (P<0.004). Tumor subtype 1, associated with short LRFS, PFS and OS, showed features of epithelial-mesenchymal transition and undifferentiation. It also overexpressed genes involved in cell adhesion, NF-κB and integrin signalling. Tumor subtype 3, associated with longer LRFS, PFS and OS, showed a high degree of differentiation and overexpressed genes located in chromosomal regions 19q13 and 1q21. Tumor subtype 2, which had an intermediate clinical outcome between subtype 1 and subtype 3, overexpressed genes involved in branching morphogenesis. Finally, we validated the association between gene cluster classification and patient survival using Gene Set Enrichment Analysis and two HNSCC data sets obtained from two independent patient cohorts. In conclusion, we generated a gene prognostic signature associated with survival in locally advanced patients using the expression profile of the pre-treatment tumor biopsy. Independent prospective studies would be necessary to assess if the proposed survival signature could help to guide clinical management of HNSCC.

Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy.

With the increasing use of concomitant chemoradiotherapy (CCRT) in the treatment of advanced head and neck carcinoma, surgery has lost ground as the first therapy and is reserved as a salvage treatment in cases of locoregional failure. The objective of our study was to review our experience in patients who had a local or regional recurrence after treatment with CCRT. Thirty-two patients underwent salvage surgery after CCRT: 24 were treated with a local or locoregional resection and 8 patients with a neck dissection only. In patients who had surgery involving the primary location of the tumor, some kind of reconstruction was required in 83% of cases. One or more postoperative complications occurred in nine patients. The median hospital stay was 18.5 days. There was a significant difference in hospital stay in relation to the appearance of surgical complications. Five-year adjusted survival after salvage surgery was 34.2% (CI 95% 13.2-55.2%). Adjusted survival was related to the status of the resection margins and appearance of neck nodes with extracapsular spread in the neck dissection. In conclusion, salvage surgery after CCRT involves extensive resections, requiring reconstruction techniques with regional or microanastomosed free flaps in most cases, achieving acceptable outcomes.

[CEA and Cyfra 21.1 study pre-treatment in 252 patients with head and neck carcinomas]. / Estudio de CEA y Cyfra 21.1 pre-tratamiento en 252 pacientes con carcinoma de cabeza y cuello.

INTRODUCTION: Squamous cell carcinoma is the most frequent malignant tumor in the head and neck. As in most malignant tumors, the earlier the diagnosis, is made the longer the survivalis. Several molecules, including CEA and Cyfra 21.1, have been evaluated in an attempt to improve diagnosis and follow-up. OBJECTIVE: To investigate whether CEA and Cyfra 21.1 present pathological increased values prior to treatment, and to correlate tumor and patient characteristics with CEA and Cyfra 21.1 levels. MATERIAL AND METHODS: CEA and Cyfra 21.1 were measured pre-treatment in sera of 252 patients treated for head and neck tumors from1999 to 2003. RESULTS: Increases of CEA were detected in 23.6%, and increases of Cyfra 21.1 in 19.1% of patients. Significative differences were found between the concentrations of Cyfra 21.1 related to the tumor stage, local extension, histological grade, and an increasing relation with age. No differences were found in relation to the primary tumor site. Regarding CEA, the only finding was an increased relation between concentrations of this marker and cigarette and alcohol habits. CONCLUSIONS: Cyfra 21.1 does not appear to be a good marker for tumoral screening of head and neck carcinomas. However, a good correlation was observed between sera concentrations of Cyfra 21.1, tumoral burden, and histological grade of the tumor, but this was not the case with CEA.

Estudio de CEA y Cyfra 21.1 Pre-tratamiento en 252 pacientes con carcinoma de cabeza y cuello / CEA and Cyfra 21.1 Study pre-treatment in 252 patients with head and neck carcinomas

Introducción: El carcinoma escamoso es el tumor maligno predominante en cabeza y cuello. Como en la mayoría de tumores malignos, su diagnóstico precoz conlleva una mayor supervivencia. Diferentes moléculas, entre ellas el CEA y el Cyfra 21.1 han sido evaluadas en un intento de facilitar el diagnóstico y la evolución de la enfermedad. Objetivo: Demostrar si existe una elevación patológica de CEA y Cyfra 21.1 pre-tratamiento en nuestros pacientes, y buscar correlación entre sus concentraciones y diferentes parámetros con relación al tumor y al paciente. Material y métodos: Se midieron antes deltratamiento las concentraciones de CEA y Cyfra 21.1 en suero en 252 pacientes entre 1999 y 2003. Resultados: Se detectó una elevación de CEA en 23,6 por ciento, y de Cyfra 21,1 en 19.1 por ciento de pacientes. Se encontró una diferencia significativa de las concentraciones de Cyfra 21.1 en función del estadiaje tumoral, la extensión local y regional, entre los diferentes grados histológicos, y una relación de tendencia creciente con la edad. No hubo diferencias significativas para las localizaciones delprimario. Respecto al CEA sólo se encontró relación de tendencia creciente con el hábito tabáquico y enólico de los pacientes. Conclusiones: El Cyfra 21.1 está lejos de ser un marcador adecuado para cribaje del carcinoma en cabeza y cuello. Existe, sin embargo, correlación entre sus concentraciones séricas y la carga de tumor y su grado de diferenciación histológica, no siendo así para el CEA (AU)

INTRODUCTION: Squamous cell carcinoma is the most frequent malignant tumor in the head and neck. As in most malignant tumors, the earlier the diagnosis, is made the longer the survivalis. Several molecules, including CEA and Cyfra 21.1, have been evaluated in an attempt to improve diagnosis and follow-up. OBJECTIVE: To investigate whether CEA and Cyfra 21.1 present pathological increased values prior to treatment, and to correlate tumor and patient characteristics with CEA and Cyfra 21.1 levels. MATERIAL AND METHODS: CEA and Cyfra 21.1 were measured pre-treatment in sera of 252 patients treated for head and neck tumors from1999 to 2003. RESULTS: Increases of CEA were detected in 23.6%, and increases of Cyfra 21.1 in 19.1% of patients. Significative differences were found between the concentrations of Cyfra 21.1 related to the tumor stage, local extension, histological grade, and an increasing relation with age. No differences were found in relation to the primary tumor site. Regarding CEA, the only finding was an increased relation between concentrations of this marker and cigarette and alcohol habits. CONCLUSIONS: Cyfra 21.1 does not appear to be a good marker for tumoral screening of head and neck carcinomas. However, a good correlation was observed between sera concentrations of Cyfra 21.1, tumoral burden, and histological grade of the tumor, but this was not the case with CEA (AU)

[Selective neck dissection in patients presenting clinical node metastases]. / Vaciamientos selectivos en pacientes con metástasis ganglionares clínicas.

OBJECTIVE: To evaluate the results obtained with selective neck dissection in patients with clinically positive neck nodes at diagnosis (N+). PATIENTS AND METHODS: Retrospective study of N+ patients treated with a lateral or supromohyoid selective neck dissection with prophylactic purpose (sides of the neck N0) or therapeutic purpose (sides of the neck N+). RESULTS: Forty nine selective neck dissections were carried out in 42 N+ patients. In 18 cases the neck dissection had a prophylactic purpose (sides of the neck N0), and in 31 of them a therapeutic purpose (sides of the neck N+). In 39 patients summary was followed by postoperative radiotherapy. There was no regional relapse in either side of the neck treated with a selective neck dissection. CONCLUSIONS: Selective neck dissections in selected N+ patients are an adequate surgical technique. The main advantages of selective neck dissections are to shorten the surgical time, and to avoid the morbility associated with the dissection of the neck zones not included.

Vaciamientos selectivos en pacientes con metástasis ganglionares clínicas / Selective neck dissection in patients presenting clinical node metastases

Objetivo: Evaluar los resultados obtenidos con el uso de vaciamientos selectivos en pacientes con metástasis ganglionares clínicas en el momento del diagnóstico (N+). Pacientes y métodos: Estudio retrospectivo de los pacientes N+ tratados con un vaciamiento selectivo lateral o supraomohioideo con finalidad profiláctica (lado de cuello N0) o terapéutica (lado de cuello N+). Resultados: Se llevaron a cabo un total de 49 vaciamientos selectivos en 42 pacientes N+. En 18 ocasiones los vaciamientos tuvieron una finalidad profiláctica (lados de cuello N0) y en 31 terapéutica (lados de cuello N+).Treinta y nueve pacientes siguieron tratamiento con radioterapia postoperatoria. No se produjo una recidiva regional en ninguno de los lados de cuello tratados con un vaciamiento selectivo. Conclusión: Los vaciamientos selectivos en casos seleccionados de pacientes N+ son una técnica adecuada de cirugía cervical, y cuentan con la ventaja de minimizar el tiempo operatorio y la morbilidad asociada a la disección de las estructuras cervicales (AU)

OBJECTIVE: To evaluate the results obtained with selective neck dissection in patients with clinically positive neck nodes at diagnosis (N+). PATIENTS AND METHODS: Retrospective study of N+ patients treated with a lateral or supromohyoid selective neck dissection with prophylactic purpose (sides of the neck N0) or therapeutic purpose (sides of the neck N+). RESULTS: Forty nine selective neck dissections were carried out in 42 N+ patients. In 18 cases the neck dissection had a prophylactic purpose (sides of the neck N0), and in 31 of them a therapeutic purpose (sides of the neck N+). In 39 patients summary was followed by postoperative radiotherapy. There was no regional relapse in either side of the neck treated with a selective neck dissection. CONCLUSIONS: Selective neck dissections in selected N+ patients are an adequate surgical technique. The main advantages of selective neck dissections are to shorten the surgical time, and to avoid the morbility associated with the dissection of the neck zones not included (AU)

[Assessment of the prognostic capacity improvement of the 5th edition of the TNM in patients with nasopharyngeal carcinoma]. / Evaluación de la mejoría en la capacidad pronóstica de la 5a edición del TNM en pacientes con carcinomas de nasofaringe.

OBJECTIVE: Evaluate the changes included in the 5th edition of the TNM classification in patients with nasopharyngeal carcinoma. PATIENTS AND METHODS: Retrospective study of 103 patients with nasopharyngeal carcinoma treated with radical intention in our centre from 1985 to 1997. A reclassification according to the criteria defined in the 5th edition of the TNM was carried out. The loco-regional control and survival obtained when patients were classified with the 4th and 5th editions of the TNM were compared. RESULTS: The use of the 5th edition of the TNM led to a decrease in local category (T) and stage grouping, improving the prognostic capacity in local control and survival. The changes included in the 5th edition of the TNM did not modify the regional classification in a essential way. CONCLUSIONS: The changes included in the 5th edition of the TNM improved the classification of patients with nasopharyngeal carcinoma.

Recidivas ganglionares aisladas en pacientes con carcinomas de cabeza y cuello / Isolated lymphatic recurrencies in patients with head and neck carcinomas

Objetivo: La existencia de una recidiva ganglionar comporta un empeoramiento notable en el pronóstico de los pacientes con carcinoma de cabeza y cuello. El objetivo del presente estudio es analizar las posibilidades de tratamiento de rescate tras una recidiva ganglionar aislada. Material y Métodos: Estudio retrospectivo de 144 pacientes con carcinomas de cabeza y cuello afectos de una recidiva regional aislada. Se analizaron los tratamientos empleados y los resultados de control regional y supervivencia. Resultados: Un 64 por ciento (92/144) de los pacientes no fueron candidatos a tratamiento de rescate con intención radical. Se efectuó un rescate quirúrgico en el 36 por ciento (52/144) restante de pacientes, obteniéndose una supervivencia ajustada en este grupo del 46 por ciento. La variable relacionada de forma más importante con la posibilidad de llevar a cabo un tratamiento de rescate fue el tratamiento inicial de las áreas ganglionares, contando con peor pronóstico los pacientes en los que el tratamiento inicial incluyó cirugía. Conclusiones: La aparición de una recidiva regional cuenta con mal pronóstico, con una supervivencia ajustada a los 5 años en nuestros pacientes del 16 por ciento. Tan sólo un 36 por ciento de los pacientes fueron considerados candidatos a un tratamiento de rescate, consiguiéndose una supervivencia en este grupo del 46 por ciento (AU)

OBJECTIVE: Recurrencies of lymphatic metastasis implies a poor prognosis in patients with head and neck carcinoma. The aim of our study is to analyse the results of salvage treatment after an isolated regional tumour recurrence. MATERIAL AND METHODS: Retrospective study of 144 patients with head and neck carcinoma with an isolated neck recurrence. The treatments used, regional control and patient's survival were analysed. RESULTS: Sixty-four percent (92/144) of patients were not candidates to salvage treatment with radical intention. Salvage surgery was performed in 36% (52/144) of patients, with a survival of 46% in this group of patients. Previous treatment of the neck was the most relevant variable to decide a salvage surgery. Patients treated initially with neck dissection had the worst prognosis. CONCLUSIONS: The existence of a regional recurrence has a bad prognosis, with 16% 5-year survival. Only 36% of patients were considered candidates to salvage treatment, achieving 46% of survival (AU)