Reirradiation for recurrent head and neck carcinoma

Purpose: To present the outcome and toxicity profile of reirradiation (re-RT) in patients with recurrent head and neck cancer (HNC). Methods: From 1995 to 2009, 35 patients underwent re-RT at our institution. Twenty-seven (77%) patients were initially diagnosed with stage III/IV disease. The median total doses of irradiation first and second courses were 66.0 Gy (range 54.0-70.0) and 55.8 Gy (range 32.5-66.6), respectively The median time from the first course of irradiation to re-RT was 25.2 months (range 8-136). Six (17%) patients underwent salvage surgery before reirradiation. Concurrent chemotherapy was administered to 18(51%) patients. Results: With a median follow-up of 12.9 months (range 2.5-109.6), the 1- and 2-year locoregional control (LRC) rates were 41 and 9%, respectively. The 1- and 2-year disease free survival (DFS) rates were 30 and 7%, respectively. The 1- and 2-year overall survival (OS) rates were 42.9 and 7.9%, respectively. Grade 3 acute toxicity was reported in 7 (20%) patients while grade 3-4 late radiation-induced complications were seen in 8(23%) patients. In univariate analysis, an improvement in OS was observed in patients with initial N0/N1 stage vs. those with N2/N3 stage (p=0.004). Prior neoadjuvant chemotherapy was associated with significantly inferior OS (p=0.028), while neoadjuvant chemotherapy in recurrence was predictive of improved LRC (p=0.041). Conclusion: re-RT in HN cancer is associated with poor prognosis, especially in patients with inoperable disease. Complications due to treatment are not infrequent. Nonetheless, our outcomes remain encouraging and applicable to a carefully selected patient population.