Nadeem Riaz1, Julian C Hong1, Eric J Sherman2, Luc Morris3, Matthew Fury2, Ian Ganly3, Tony J C Wang4, Weji Shi5, Suzanne L Wolden1, Andrew Jackson1, Richard J Wong3, Zhigang Zhang5, Shyam D Rao1, Nancy Y Lee6. 1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, United States. 2. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, United States. 3. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, United States. 4. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, United States. 5. Department of Radiation Oncology, Columbia University, New York, United States. 6. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, United States. Electronic address: leen2@mskcc.org.
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.
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.
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