title: Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation.
abstract: BACKGROUND
  It has been shown that concomitant chemotherapy (C) with reirradiation (ReRT) is feasible and effective for select patients with recurrent or second primary head and neck cancer (HNC). To examine potential prognostic factors associated with survival, the authors of this report retrospectively reviewed the outcomes of patients who received CReRT.
  
  
  METHODS
  The study cohort comprised previously irradiated patients with nonmetastatic disease from 9 consecutive phase 1 and 2 protocols for poor-prognosis HNC. For all patients, reirradiation (ReRT) was delivered with concurrent chemotherapy. Chemotherapy generally was 5-fluorouracil, hydroxyurea, and a third agent.
  
  
  RESULTS
  One hundred sixty-six patients were identified, including 81 patients who underwent surgical resection or debulking before enrollment. The median ReRT dose was 66 gray. After a median follow-up of 53 months among surviving patients, the median overall survival (OS) was 10.3 months. The 2-year rates for OS, disease-free survival, locoregional control, and freedom from distant metastasis were 24.8%, 19.9%, 50.7%, and 61.4%, respectively. Thirty-three patients (19.9%) died of treatment-related toxicity. In subgroup analysis, survival was significantly reduced in patients who received previous concurrent chemoradiotherapy (CRT) compared with patients who were naive to CRT (2-year OS rate, 10.8% vs 28.4%; P = .0043). In multivariable analysis, prior CRT was associated independently with OS along with surgery before protocol treatment, full-dose ReRT, and radiotherapy interval.
  
  
  CONCLUSIONS
  CReRT achieved a long-term cure for a small group of patients with recurrent or second primary HNC. Previous treatment with CRT was among the important prognostic factors for survival. Because of the associated risk of severe toxicity, CReRT should be limited only to carefully selected patients.
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Choe
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Haraf
authors.forename: Abhishek
authors.initials: A
authors.lastname: Solanki
authors.forename: Ezra E W
authors.initials: EE
authors.lastname: Cohen
authors.forename: Tanguy Y
authors.initials: TY
authors.lastname: Seiwert
authors.forename: Kerstin M
authors.initials: KM
authors.lastname: Stenson
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Blair
authors.forename: Louis
authors.initials: L
authors.lastname: Portugal
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Villaflor
authors.forename: Mary Ellyn
authors.initials: ME
authors.lastname: Witt
authors.forename: Everett E
authors.initials: EE
authors.lastname: Vokes
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000628:therapy*; D011379:Prognosis; D011879:Radiotherapy Dosage; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005472:Fluorouracil; D006918:Hydroxyurea