title: Reirradiation for head-and-neck cancer: delicate balance between effectiveness and toxicity.
abstract: OBJECTIVE
  To analyze the effectiveness and toxicity of reirradiation (re-RT) for head-and-neck cancer.
  
  
  METHODS
  A retrospective data analysis was performed of 58 patients who underwent re-RT with curative intent. Re-RT was given as definitive treatment in 53% of patients, whereas salvage surgery preceded reirradiation in 47%. The median cumulative RT dose was 119 Gy (range, 76-140). Concurrent chemotherapy was administered with re-RT (CRT) in 57% of patients. Event-free survival was defined as survival without recurrence and without serious toxicity (≥Grade 3).
  
  
  RESULTS
  Median follow-up was 57 months (range, 9-140). Locoregional (LR) control was 50% at 2 and 5 years. The 2-year and 5-year overall survival (OS) was 42% and 34%. The following factors were associated with improved OS: postoperative re-RT (vs. primary re-RT), treatment with RT only (vs. CRT) and interval >3 years between previous RT and re-RT. For patients treated with postoperative re-RT and definitive re-RT, the 5-year OS was 49% and 20%, respectively. Patients treated with CRT had a 5-year OS of 13%. Serious (late) toxicity ≥Grade 3 was observed in 20 of 47 evaluable patients (43%). Three cases of treatment-related death were recorded. The 2- and 5-year serious toxicity-free interval was 59% and 55%, respectively. Associated with increased risk of serious toxicity were CRT and higher re-RT dose. The event-free survival rates at 2 and 5 years were 34% and 31%, respectively.
  
  
  CONCLUSIONS
  Re-RT in head-and-neck cancer is associated with poor survival rates of 13-20% in patients with inoperable disease treated with primary (chemo-) re-RT. For this subgroup, however, no other curative options are available. Long-term disease control and survival can be achieved in patients who receive re-RT as an adjunct to surgical resection. The rates of serious toxicity after re-RT are high, with an incidence of approximately 45% at 5 years. Approximately 1 in 3 patients survived re-RT without recurrence and severe complications.
authors.affiliation: Maastricht University Medical Center, Department of Radiation Oncology (MAASTRO clinic), GROW School for Oncology and Developmental Biology, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands. frank.hoebers@maastro.nl
authors.forename: Frank
authors.initials: F
authors.lastname: Hoebers
authors.forename: Wilma
authors.initials: W
authors.lastname: Heemsbergen
authors.forename: Suzanne
authors.initials: S
authors.lastname: Moor
authors.forename: Marta
authors.initials: M
authors.lastname: Lopez
authors.forename: Martin
authors.initials: M
authors.lastname: Klop
authors.forename: Margot
authors.initials: M
authors.lastname: Tesselaar
authors.forename: Coen
authors.initials: C
authors.lastname: Rasch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011879:Radiotherapy Dosage; D019233:Retreatment / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden