Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation

Kevin S. Choe, Daniel J. Haraf, Abhishek Solanki, Ezra E W Cohen, Tanguy Y. Seiwert, Kerstin M. Stenson, Elizabeth A. Blair, Louis Portugal, Victoria M. Villaflor, Mary Ellyn Witt, Everett E. Vokes, Joseph K. Salama

Research output: Contribution to journalArticle

48 Scopus citations

Abstract

BACKGROUND: It has been shown that concomitant chemotherapy (C) with reirradiation (ReRT) is feasible and effective for select patients with recurrent or second primary head and neck cancer (HNC). To examine potential prognostic factors associated with survival, the authors of this report retrospectively reviewed the outcomes of patients who received CReRT. METHODS: The study cohort comprised previously irradiated patients with nonmetastatic disease from 9 consecutive phase 1 and 2 protocols for poor-prognosis HNC. For all patients, reirradiation (ReRT) was delivered with concurrent chemotherapy. Chemotherapy generally was 5-fluorouracil, hydroxyurea, and a third agent. RESULTS: One hundred sixty-six patients were identified, including 81 patients who underwent surgical resection or debulking before enrollment. The median ReRT dose was 66 gray. After a median follow-up of 53 months among surviving patients, the median overall survival (OS) was 10.3 months. The 2-year rates for OS, disease-free survival, locoregional control, and freedom from distant metastasis were 24.8%, 19.9%, 50.7%, and 61.4%, respectively. Thirty-three patients (19.9%) died of treatment-related toxicity. In subgroup analysis, survival was significantly reduced in patients who received previous concurrent chemoradiotherapy (CRT) compared with patients who were naive to CRT (2-year OS rate, 10.8% vs 28.4%; P =.0043). In multivariable analysis, prior CRT was associated independently with OS along with surgery before protocol treatment, full-dose ReRT, and radiotherapy interval. CONCLUSIONS: CReRT achieved a long-term cure for a small group of patients with recurrent or second primary HNC. Previous treatment with CRT was among the important prognostic factors for survival. Because of the associated risk of severe toxicity, CReRT should be limited only to carefully selected patients. Cancer 2011;. © 2011 American Cancer Society. For patients with recurrent head and neck cancer in a previously irradiated area, concomitant chemotherapy with reirradiation is a treatment option that offers a small but real chance of cure in select patients. The results of the current study indicate that previous treatment with chemoradiotherapy was an important pretreatment characteristic and was associated with poor survival.

Original languageEnglish (US)
Pages (from-to)4671-4678
Number of pages8
JournalCancer
Volume117
Issue number20
DOIs
StatePublished - Oct 15 2011

Keywords

  • chemoradiotherapy
  • head and neck cancer
  • prognostic factor
  • recurrent and second primary
  • reirradiation

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Choe, K. S., Haraf, D. J., Solanki, A., Cohen, E. E. W., Seiwert, T. Y., Stenson, K. M., Blair, E. A., Portugal, L., Villaflor, V. M., Witt, M. E., Vokes, E. E., & Salama, J. K. (2011). Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation. Cancer, 117(20), 4671-4678. https://doi.org/10.1002/cncr.26084