Re-irradiation versus systemic therapy for the management of local-regionally recurrent head and neck cancer

Allen M Chen; Jeremy P Harris; Rupali Nabar; Tjoson Tjoa; Yarah Haidar; William B Armstrong

doi:10.1016/j.radonc.2024.110278

Re-irradiation versus systemic therapy for the management of local-regionally recurrent head and neck cancer

Radiother Oncol. 2024 Apr 16:196:110278. doi: 10.1016/j.radonc.2024.110278. Online ahead of print.

Authors

Allen M Chen¹, Jeremy P Harris², Rupali Nabar³, Tjoson Tjoa⁴, Yarah Haidar⁴, William B Armstrong⁴

Affiliations

¹ Department of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States. Electronic address: allenmc2@uci.edu.
² Department of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States.
³ Department of Internal Medicine, Division of Hematology-Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States.
⁴ Department of Otolaryngology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States.

PMID: 38636710
DOI: 10.1016/j.radonc.2024.110278

Abstract

Purpose: The optimal management of local-regionally recurrent head and neck cancer that is not amenable to surgical resection is uncertain. We sought to compare outcomes among patients treated with and without re-irradiation in this setting.

Methods and materials: A review of institutional registries identified 65 patients with local-regionally recurrent squamous cell carcinoma of the head and neck who were ineligible for surgery. Forty patients (62 %) opted for re-irradiation with the remaining 25 patients (38 %) undergoing initial systemic therapy alone. All patients had measurable disease. Forty-three patients (66 %) were male and twenty-two (33 %) were female. The median age at the time of recurrence was 59 years (range, 39-84 years). The most common primary sites of disease were the oropharynx, (n = 25), oral cavity (N = 19), and nasopharynx (n = 11). The median interval from completion of prior radiation to the diagnosis of recurrent disease was 35 months (range, 2-102 months).

Results: Re-irradiation improved 2-year overall survival, (32 % versus 11 %), progression-free survival (31 % versus 7 %), and local-regional control (39 % versus 3 %) compared to systemic therapy alone (p < 0.05, for both). The likelihood of developing any new grade 3+ toxicity was significantly higher among patients treated by re-irradiation compared to those treated by systemic therapy (53 % vs. 28 %, p < 0.001). There were 3 treatment-related fatalities, all of which occurred in the re-irradiation group. The incidence of grade 3+ late toxicity was 48 % and 12 % for patients in the re-irradiation and systemic therapy cohorts, respectively (p < 0.001).

Conclusion: Although re-irradiation improved overall survival compared to systemic therapy for appropriately selected patients with local-regionally recurrent head and neck cancer, the relatively high risk of toxicity must be considered.

Keywords: Head and neck cancer; Re-irradiation; Recurrent; Salvage; Systemic therapy.