Reirradiation in patients with recurrent head-and-neck carcinoma

Abstract

Context: In head-and-neck cancers (HNCs), the incidence of recurrence after radiation therapy or the second primary tumors is 30%–50% and 20%, respectively. With an operable recurrence, surgical resection is considered the standard of care. For patients presenting with unresectable recurrence or medically unfit for surgery, definitive reirradiation with chemotherapy is the only potentially curative treatment. Aims: The aim of this study was to evaluate locoregional control (LRC), overall survival (OS), and toxicity in patients receiving reirradiation for recurrent HNCs. Subjects and Methods: Records of 35 patients reirradiated with three-dimensional conformal radiotherapy and intensity-modulated radiotherapy (IMRT) for HNC between January 2013 and June 2015 were reviewed and analyzed. Patients were followed on a quarterly basis for 2 years. The Radiation Therapy Oncology Group morbidity criteria were employed to assess the acute and late toxicity. LRC and OS were calculated from the final day of radiation treatment using the Kaplan–Meier method. Results: The median follow-up was 14 months. The median time interval between initial radiation and reirradiation was 51 months (range 12–240 months). The median reirradiation dose was 60 Gray (Gy) (range 24–70 Gy). Eight (23%) patients underwent prior salvage surgical resection. The 1-year OS and LRC rates were 48% and 60%, respectively. Severe Grade 3-4 reirradiation-related toxicity occurred in 12 patients (34.28%). Conclusions: The present study achieved local control and OS comparable to patients with available literature. The treatment-related morbidity was higher as all patients did not receive IMRT in reirradiation setting.