Results of postoperative reirradiation for recurrent or second primary head and neck carcinoma

Abstract

In this prospective study, the effects of a second course of postoperative radiation therapy on locoregional control, survival, toxicity, and quality of life were investigated in patients who underwent resection of a second primary or locoregional recurrent head and neck tumor in a previously irradiated area. In total, 39 patients who underwent surgery for second primary tumors (n = 19 patients) or for recurrent locoregional tumors (n = 20 patients) were retreated with postoperative radiotherapy (RE-PORT). Indications for RE-PORT were extranodal spread (49%), positive surgical margins (44%), and/or other risk factors (8%). The target volume for RE-PORT was confined to the high-risk area. No elective radiotherapy was applied in regions that were situated in the formerly high-dose area. A total dose of 46 grays (Gy) was given to elective areas with boosts from 60 Gy to 66 Gy to the high-risk region with conventional fractionation. The results of RE-PORT were compared with the results from patients who were treated in the same period with primary adjuvant radiotherapy (PRI-PORT) at the authors' institution. The mean follow-up was 32 months (range, 3-84 mos). The locoregional control rate after 3 years in the RE-PORT group was 74%, and the 3-year overall survival rate was 44%. This did not differ significantly compared with survival rates in the PRI-PORT group. Although a higher rate of late radiation-induced morbidity and more head and neck symptoms were observed in the RE-PORT group compared with the PRI-PORT group, no differences were observed with regard to the more general dimensions of quality of life. RE-PORT after surgery for recurrent locoregional tumors and/or second primary tumors should be considered in patients who have high-risk histopathologic features.