title: Second course of radiation for new primary head-and-neck cancer: population-based study of survival.
abstract: OBJECTIVE
  To analyze patient and tumor characteristics, and survival of patients who received 2 courses of radiotherapy for different primary head and neck cancers (HNCs).
  
  
  METHODS
  A total of 234 patients who underwent 2 courses of radiotherapy for different primary, localized, or regional HNCs registered in the population-based Surveillance, Epidemiology, and End Results database were identified.
  
  
  RESULTS
  The latency between first and second irradiated HNCs ranged from 0.3 to 28.8 years (median, 6.3 years). Only 22% of first irradiated HNCs were node positive, and only 22% of second irradiated HNCs were node positive. After the diagnosis of the second irradiated HNC, the 1-, 2-, and 5-year overall survivals were 68%, 40%, and 17%, respectively. The variables of gender, race, latency, and stage of second cancer did not significantly impact survival. At the time of diagnosis of second irradiated HNC, younger age (P = 0.026), later year of diagnosis (P = 0.005), and cancer-directed surgery (P = 0.032) were favorable predictors of improved survival. With Cox regression analyses, younger age (P = 0.060) and cancer-directed surgery for the second irradiated HNC (HR = 0.75, 95% CI: 0.55-1.01, P = 0.062) were borderline significantly favorable risk factors, whereas year of diagnosis (P = 0.13) was not.
  
  
  CONCLUSIONS
  From a population-based analysis, patients undergoing a second course of radiation for HNC appear to benefit from cancer-directed surgery, although this did not reach statistical significance with Cox regression analyses. The improved outcome after resection is perhaps attributable to a therapeutic benefit from surgery and/or more indolent disease among those amenable to resection.
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, NY, USA. MTMilano@yahoo.com
authors.forename: Michael T
authors.initials: MT
authors.lastname: Milano
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000401:mortality* / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control*; D012074:Remission Induction; D018426:SEER Program; D015996:Survival Rate; D016896:Treatment Outcome