Abstract
Background and purpose
Loco-regionally recurrent head and neck cancer (HNC) in the setting of prior radiotherapy
carries significant morbidity and mortality. The role of re-irradiation (re-RT) remains
unclear due to toxicity. We determined prognostic factors for loco-regional control
(LRC) and formulated a nomogram to help clinicians select re-RT candidates.
Material and methods
From July 1996 to April 2011, 257 patients with recurrent HNC underwent fractionated
re-RT. Median prior dose was 65 Gy and median time between RT was 32.4 months. One hundred fifteen patients (44%) had salvage surgery and 172 (67%) received
concurrent chemotherapy. Median re-RT dose was 59.4 Gy and 201 (78%) patients received IMRT. Multivariate Cox proportional hazards were
used to identify independent predictors of LRC and a nomogram for 2-year LRC was constructed.
Results
Median follow-up was 32.6 months. Two-year LRC and overall survival (OS) were 47% and 43%, respectively. Recurrent
stage (P = 0.005), non-oral cavity subsite (P < 0.001), absent organ dysfunction (P < 0.001), salvage surgery (P < 0.001), and dose >50 Gy (P = 0.006) were independently associated with improved LRC. We generated a nomogram with
concordance index of 0.68.
Conclusion
Re-RT can be curative, and our nomogram can help determine a priori which patients
may benefit.
Keywords
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Article info
Publication history
Published online: June 30, 2014
Accepted:
June 2,
2014
Received in revised form:
May 26,
2014
Received:
July 29,
2013
Footnotes
☆Presented in part at the American Society for Radiation Oncology Annual Meeting, Boston, MA, October 28–November 31, 2012.
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
