Prognostic factors in patients with recurrent head and neck cancer treated with reirradiation

The aim of this study was to determine the prognostic factors concerning overall survival (OS) and progression- free survival (PFS) following reirradiation in patients with recurrent squamous cell head and neck cancer (HNC).

We performed a retrospective analysis on 65 recurrent HNC patients treated with reirradiation for local/locoregional recurrence between 1999 and 2004 at the Institute of Radiotherapy and Oncology in Skopje. The initial treatment of their HNC consisted of radiotherapy following surgery, radiotherapy alone, or concurrent chemoradiotherapy.

The median reirradiation dose was 39.8 Gy (range 24-58). Clinically complete response (CR) was observed in 9 (13.9%) patients. The median OS and PFS was 8 months (range 1-22) and 4.9 months (range 0-18), respectively. The univariate analysis of prognostic factors identified Karnofsky performance status (KPS), response to reirradiation, dose to recurrent site, and disease-free interval (DFI) as strongly associated with both OS and PFS. Initial tumor site and cumulative dose had a significant influence only on OS. Multivariate analysis revealed that response to reirradiation and the radiation dose to the recurrent site were two independent variables significantly influencing OS (p<0.0001 and p=0.049, respectively). The only significant independent prognostic factor for PFS was response to reirradiation (p=0.0008).

The necessity of improvement of patients' outcome allows us to consider concurrent chemoradiotherapy as a more efficient treatment strategy that has a potential to increase the response to reirradiation of unresectable recurrent HNC. Using higher radiation doses is also expected to enhance the response rates and consequently to positively influence OS and PFS.