Background: Concurrent CRT is standard treatment for patients with SCCA. We explored the results of surgical salvage with APER in ACT II, which compared 5FU/CisP with 5FU/MMC concurrent with a uniform RT dose (50.4Gy, 28 daily fractions of 1.8Gy), and a second randomization to maintenance chemotherapy. Methods: The ACT II trial recruited 940 patients. We examined the overall survival of patients from the time of salvage surgery post CRT according to 4 time periods: Group A - operated ≤ 6 months of CRT (n = 19); Group B - between > 6 and ≤ 12 months (n = 36); Group C - between > 12 and ≤ 24 months (n = 28); Group D - after > 24 months (n = 18) respectively. Results: There were 291 disease failures (31%) overall - males, total radiation dose, and tumor stage were independent predictors of local failure. Of 291 relapses, surgical salvage with APER was attempted in 107 (37%) loco-regional failures of whom 101 were evaluable and 53 subsequently died. The 2-year OS rates after local disease failure from time of salvage APER to death from any cause was 54% (43%-63%). Rates of OS beyond 2 years are unreliable given the small number of patients at risk after 2 years. Death rate after salvage APER was 15/19(79%), 21/36(58%), 12/28(43%) and 5/18(28%) in Groups A, B, C and D. Conclusions: In the management of SCCA, local failure may benefit from early detection and salvage by radical surgery. Results of radical surgery performed in ACT II in 37% compare with 56% in ACT I. These observations suggest close imaging with MRI and clinical surveillance may be helpful in the first 2 years, and imply the need for a trial to test further systemic interventions such as chemotherapy peri-operatively. Clinical trial information: 26715889.