Locoregionally recurrent head and neck squamous cell carcinoma: incidence, survival, prognostic factors, and treatment outcomes

Abstract

PurposeFor locoregionally recurrent head and neck squamous cell carcinoma (HNSCC), appropriate therapeutic decisions remain unclear. We examined the treatment outcomes of a national cohort to determine suitable treatments for and prognostic factors in patients with locoregionally recurrent HNSCCs at different stages and sites.Patients and methodsWe analyzed data of >20-year-old patients with HNSCC at American Joint Committee on Cancer clinical stages I–IV without metastasis from Taiwan National Health Insurance and cancer registry databases. The index date was the date of recurrent HNSCC diagnosis. Recurrent HNSCC was defined as the annotation of locoregional recurrence with tissue proof in cancer registry databases. The enrolled patients were categorized into three groups: Group 1 comprised those undergoing chemotherapy (CT) alone; Group 2 comprised those receiving reirradiation (re-RT) alone (total radiation dose ≥ 60 Gy through intensity modulation radiation therapy [IMRT]); Group 3 comprised those receiving concurrent chemoradiotherapy (CCRT) alone (irradiation total dose ≥60 Gy through IMRT); and Group 4 comprised those receiving salvage surgery with or without RT or CT.ResultsWe enrolled 4,839 and 28,664 HNSCC patients with and without locoregional recurrence, respectively (median follow-up, 3.25 years). Locoregional recurrence rate and incidence were 14.44% and 40.73 per 1,000 person-years, respectively. Age ≥ 65 years, Charlson comorbidity index (CCI) score > 6, advanced clinical stage at first diagnosis, and recurrence-free interval < 1 year were significant independent prognostic risk factors for overall survival as per univariate and multivariate Cox regression analyses. After adjusting for age, sex, CCI scores, clinical stage at first diagnosis, and recurrence-free interval, adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for overall mortality in recurrent clinical stages I and II were 0.63 (0.45–0.89, p = 0.009), 0.65 (0.52–0.83, p < 0.001), and 0.32 (0.26–0.40, p < 0.001) in Groups 2, 3, and 4, respectively, whereas they were 1.23 (0.99–1.52, p = 0.062), 0.69 (0.60–0.79, p < 0.001), and 0.39 (0.34–0.44, p < 0.001) for Groups 2, 3, and 4, respectively, for overall mortality in recurrent clinical stage III and IV.ConclusionsAge, CCI score, clinical stage at first diagnosis, and recurrence-free interval are significant independent prognostic factors for overall survival of recurrent HNSCC patients. Regardless of recurrence stage or site, salvage surgery is the recommended first recurrent HNSCC treatment choice. Re-RT alone and CCRT are more suitable for inoperable recurrent early-stage oral and nonoral cavity recurrent HNSCCs, respectively.

Adjuvant radiotherapy and chemotherapy improve survival in patients with pancreatic adenocarcinoma receiving surgery: adjuvant chemotherapy alone is insufficient in the era of intensity modulation radiation therapy

“…Our protocols were reviewed and approved by the Institutional Review Board of Taipei Medical University. The Cancer Registry database of the Collaboration Center of Health Information Application contains detailed cancer-related information on clinical stages, RT doses, RT techniques, and CT regimens used [17][18][19][20][21][22][23][24].…”

Recurrent aphthous stomatitis may be a precursor or risk factor for specific cancers: A case‐control frequency‐matched study

“…The NHIRD is maintained by the NHI program, which is a compulsory program established in 1995 that insures 99% of all residents of Taiwan (approximately 23 million). Hundreds of articles based on NHIRD data have been published in peer‐reviewed international journals14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 and the detailed data provided in these articles have supported the work of physicians and policymakers 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26. Individual information was anonymized before the NHIRD was released for research purposes.…”

Metabolic tumor volume and total lesion glycolysis predict tumor progression and survival after salvage surgery for recurrent oral cavity squamous cell carcinoma

“…The locoregional recurrence rate after definitive treatment for OCC is 15%‐40%, varying depending on tumor size and depth of invasion, nodal status, and the subsite in the oral cavity . Surgical salvage is the recommended choice for the first recurrent OCC, regardless of stage or location at recurrence . Nonsurgical re‐irradiation and systemic intervention have also been attempted to eradicate recurrent diseases .…”