Organ and Function Preservation: The Role of Surgery as the Optimal Primary Modality or as Salvage After Chemoradiation Failure

The treatment for squamous cell carcinoma (SCC) of the head and neck has advanced considerably with the use of multimodality therapy including radiation, chemotherapy, and surgery. Efforts to achieve greater rates of disease control and survival have been coupled with attempts to reduce acute and chronic toxicity and preserve function. In the setting of advanced-stage disease, these goals have typically been achieved via the use of combined radiation and chemotherapy. Although very effective, (chemo)radiation does not always succeed and may not offer benefits to the patient equal to those achieved with surgical resection and reconstruction. This article discusses the issues involved in the selection of surgical therapy both for the primary treatment of SCC of the head and neck and for salvage of disease persistence or recurrence after chemoradiation.