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.

Kelly K Curtis,Robert L Foote,William W Wong,Ajay B Patel,Michele Y Halyard,Ashley L Garrett,Theresa A Jizba,Heidi E Kosiorek,Helen J Ross,Samir H Patel,Stephen J Ko

doi:10.1186/s13014-016-0630-x

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.

Highlights

We 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)
We retrospectively reviewed the medical records of LRR/NP SCCHN patients treated with curative-intent definitive (DRRT) or post-operative reirradiation (PRRT) with or without chemotherapy from January 1, 2003 through December 31, 2011
Primary aims were to determine patient characteristics, doses and techniques of radiotherapy used, the number of patients given chemotherapy and type of chemotherapy given, and to calculate survival outcomes including loco-regional relapse free survival (LRFS), distant metastasis free survival (DMFS), and the overall survival (OS) of LRR/NP SCCHN patients treated with RRT at our institution over this time period

Summary

Introduction

We 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). Curative-intent treatment options for patients with loco-regionally recurrent or new primary SCCHN (LRR/ NP SCCHN) include surgical salvage alone, surgery followed by radiotherapy with or without chemotherapy, or radiotherapy with or without chemotherapy for nonsurgical candidates. RRT confers increased risk of serious side effects, including but not limited to myelopathy, osteoradionecrosis of the mandible (ORN), tracheo-esophageal fistulae and fatal carotid artery hemorrhage. Despite these risks, most studies show that RRT cures a modest percentage of LRR/NP SCCHN patients with acceptable rates of serious toxicities [5]. We included only patients treated in the contemporary era, when intensity modulated radiation therapy (IMRT) was used for most patients

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