Randomized Trial of Postoperative Reirradiation Combined With Chemotherapy After Salvage Surgery Compared With Salvage Surgery Alone in Head and Neck Carcinoma

Abstract

Full-dose reirradiation combined with chemotherapy after salvage surgery significantly improved DFS, but had no significant impact on OS. An increase in both acute and late toxicity was observed.

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

“…This is not clearly better than the results from the current study or other retrospective analyses 29, 30. In the postoperative reirradiation setting, Janot et al31 reported on 130 patients who underwent macroscopic radical salvage surgery, and were randomly assigned to either receive reirradiation combined with concomitant chemotherapy versus no adjuvant treatment. Locoregional control in the treatment arm was significantly better with increased toxicity, although no difference in OS was observed.…”

Boron Neutron Capture Therapy in the Treatment of Locally Recurred Head-and-Neck Cancer: Final Analysis of a Phase I/II Trial

“…For example, in one report 16.5% of the patients treated with reirradiation plus chemotherapy died of treatment-related toxicity, 11% required surgery for osteoradionecrosis of the mandible, and 57% were dependent on gastrostomy tube feedings during follow-up (7). Similarly, a randomized study that compared salvage surgery followed by reirradiation plus concomitant chemotherapy with salvage surgery alone found reirradiation to be associated with significantly improved locoregional control and disease-free survival whereas overall survival did not improve, which was in part because of more frequent treatment-related deaths and second primary cancers in the radiotherapy arm (6). However, little is known about long-term toxicity of BNCT.…”

“…Palliative chemotherapy is regarded as a standard treatment, but full-dose, repeat irradiation is an option for selected patients and may result in durable control in approximately 10% of such patients (4)(5)(6)(7). However, reirradiation with or without concomitant chemotherapy is associated with a risk for severe organ injury due to a high accumulated radiation dose in up to 80% of the patients and treatment-related death in up to 15% (4)(5)(6)(7)(8). Efficient, well-tolerated treatment options are lacking, and patients with unresectable recurrent head-andneck carcinoma pose a difficult therapeutic problem.…”

Salvage surgery for head and neck squamous cell carcinoma

“…A phase III multi-center study of recurrent HNSCC in previously irradiated post-salvage surgery randomized patients to post-operative observation or reirradiation with concurrent chemotherapy groups. local disease control and disease-free survival were improved in the patients who received re-irradiation and chemotherapy [41], although there was no significant difference in overall survival compared with those observed after salvage surgery alone. Grade 3 and 4 toxicity was as high as 40 % compared with 10 % in those randomized to post-operative observation.…”