Outcomes of patients with loco-regionally recurrent or new primary squamous cell carcinomas of the head and neck treated with curative intent reirradiation at Mayo Clinic

Abstract

BackgroundWe reviewed outcomes of patients with loco-regionally recurrent (LRR) or new primary (NP) squamous cell carcinoma of the head and neck (SCCHN) treated at our institution with reirradiation (RRT).MethodsPatients received definitive RRT (DRRT) or post-operative RRT following salvage surgery (PRRT) from 2003 to 2011. Measured survival outcomes included loco-regional relapse free survival (LRFS) and overall survival (OS).ResultsAmong 81 patients (PRRT, 42; DRRT, 39), median PRRT and DRRT doses were 60 Gy (12–70 Gy) and 69.6 Gy (48–76.8 Gy). The majority of patients received IMRT-based RRT (n = 77, 95 %). With median follow-up of 78.1 months (95 % CI, 56–96.8 months), 2-year OS was 53 % with PRRT and 48 % with DRRT (p = 0.12); 23 % of patients were alive at last follow-up. LRFS at 2 years was 60 %, and did not differ significantly between PRRT and DRRT groups. A trend toward inferior LRFS was noted among patients receiving chemotherapy with RRT versus RRT alone (p = 0.06). Late serious toxicities were uncommon, including osteoradionecrosis (2 patients) and carotid artery bleeding (1 patient, non-fatal).ConclusionsOS of PRRT- and DRRT-treated patients in this series appears superior to the published literature. We used IMRT for the majority of patients, in contrast to several series and trials previously reported, which may account in part for this difference. Future studies should seek to improve outcomes among patients with LRR/NP SCCHN via alternative therapeutic modalities such as proton radiotherapy and by incorporating novel systemic agents.

Reirradiation of head and neck cancer: Long‐term disease control and toxicity

“…The importance of long‐term follow‐up for proper estimations of late complication and survival rates has been clearly documented 16, 17. Previously reported 2‐year locoregional control rates after reirradiation range from 10% to 64%, but long‐term follow‐up data are scarce 11, 12, 18, 19, 20, 21. OS rates in these reports vary from 10% to 58% depending on patient selection criteria.…”

“…In comparison, other retrospective reirradiation studies have reported higher rates ranging up to 80%. 21 Although, in our center, every reirradiation patient is considered individually, therefore, the addition of concurrent chemotherapy for reirradiation is not considered standard of care, resulting in lower rates in comparison with other centers. For the limited amount of patients treated with chemotherapy in our cohort, no differences in tumor control or OS were observed.…”

Reirradiation of head and neck cancer using modern highly conformal techniques

“…Interestingly, 2 studies reported worse outcomes with concurrent chemotherapy, 11,37 although this finding is likely due to treatment bias, as patients with advanced-stage disease and high-risk features were more likely to receive concurrent chemotherapy. Interestingly, 2 studies reported worse outcomes with concurrent chemotherapy, 11,37 although this finding is likely due to treatment bias, as patients with advanced-stage disease and high-risk features were more likely to receive concurrent chemotherapy.…”

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

“…However, our results and the trend of therapeutic outcomes were similar to those of previous studies. [1,3,11,19] In this study, we suggested that recurrent earlystage HNSCC should be treated with salvage surgery with or without RT or CT as first choice. If the patient is inoperable, re-RT alone or CCRT can be feasibly applied for recurrent early-stage HNSCC.…”

“…Intensity modulation radiation therapy (IMRT) at a high radiation dose (≥60 Gy) has shown more favorable overall survival in heterogeneous populations containing patients with nasopharyngeal cancer, salivary gland cancer, laryngeal cancer, metastatic tumors, multifocal cancer sites, unclear recurrence stage, recurrent HNSCC, and secondary primary cancer. [3,19,20] To resolve these complicated questions, in this study, we enrolled patients with only locoregionally recurrent HNSCC. CT alone may be selected in cases of multiple comorbidity, old age, advanced recurrence stage, and difficult-to-approach cancer site.…”