Predictors of acute toxicity and flap failure after adjuvant treatment for locally advanced head and neck cancer.

Background: Reconstructive surgery with flaps plays a key role in the head and neck region, but the potential toxicity of adjuvant treatment on flap are uncertain. Aim: to identify possible predictors of acute toxicity and flap failure in patients affected by head and neck cancer (HNC) who underwent surgery with flap reconstruction and adjuvant radiotherapy. Materials and methods: We retrospectively analyzed clinical data of 46 patients affected by locally advanced HNC, who underwent surgery with major reconstruction, followed by adjuvant treatment (radiotherapy +/- chemotherapy), between December 2005 and December 2022. Results: pN status and type of flap are the only two independent predictors of severe acute toxicity (p = 0,018 and p = 0,038 respectively) but none of the variables seems influencing per se the viability of the reconstructive flap at multivariate analysis. However, radiation-induced flap fibrosis occurred most commonly in the pedicled flap group. Conclusions and significance: This study was able to confirm the favorable integration of reconstructive flaps in advanced HNC patients, highlighting the robustness and resilience of the reconstructive flap even after adjuvant treatments. It contributes to the existing literature by identifying pN status and flap type as significant predictors of toxicity in locally advanced HNC patients undergoing adjuvant treatment.