Re-irradiation with concurrent chemotherapy in recurrent head and neck cancer: a decision analysis model based on a systematic review.
OBJECTIVE
Local recurrence is the major cause of treatment failure in head and neck cancer patients after radiation or combined therapy. If surgically unresectable, management involves supportive care or chemotherapy with palliative intent. Recent studies have assessed the role of re-irradiating these patients with concurrent chemotherapy (CTReRT) and have reported improved local control. The aim of this study was to perform a decision analysis model comparing quality adjusted life years (QALYs) between patients undergoing CTReRT and best supportive care for radio-recurrent head and neck squamous cancer.


METHODS
Outcome data from recent reviews on the topic were used. A decision analysis model was generated. An expert panel arrived at a consensus to assign utility values for the various health state outcomes when CTReRT is administered for recurrent cancer, or in the setting of palliative care for these patients.


METHODS
Quality adjusted life years from the decision analysis model.


RESULTS
Patients who do not suffer a severe complication following CTReRT were assigned by the expert panel to have a utility value of 0.7, and those who suffered one, a utility value of 0.6. A value of 1.0 equates to perfect health and 0 to death. The utility value assigned in the setting of good palliation was 0.8, with 0.6 given when symptom control was less than optimal. The model showed superior QALYs for the CTReRT arm of approximately 5 weeks (20 weeks versus 15 weeks for palliation).


CONCLUSIONS
Re-irradiation with concurrent chemotherapy is a modality to be considered in select patients with recurrent head and neck cancer. These results should help to better inform both patients and clinicians when considering this treatment.
Paleri
V
V
Department of Otolaryngology-Head & Neck Surgery, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK. vinidh.paleri@ncl.ac.uk
Kelly
C G
CG
D003131:Combined Modality Therapy; D003661:Decision Support Techniques; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008962:Models, Theoretical; D009364:Neoplasm Recurrence, Local; D011336:Probability; D015996:Survival Rate