title: A nomogram to predict loco-regional control after re-irradiation for head and neck cancer.
abstract: OBJECTIVE
  Loco-regionally recurrent head and neck cancer (HNC) in the setting of prior radiotherapy carries significant morbidity and mortality. The role of re-irradiation (re-RT) remains unclear due to toxicity. We determined prognostic factors for loco-regional control (LRC) and formulated a nomogram to help clinicians select re-RT candidates.
  
  
  METHODS
  From July 1996 to April 2011, 257 patients with recurrent HNC underwent fractionated re-RT. Median prior dose was 65 Gy and median time between RT was 32.4 months. One hundred fifteen patients (44%) had salvage surgery and 172 (67%) received concurrent chemotherapy. Median re-RT dose was 59.4 Gy and 201 (78%) patients received IMRT. Multivariate Cox proportional hazards were used to identify independent predictors of LRC and a nomogram for 2-year LRC was constructed.
  
  
  RESULTS
  Median follow-up was 32.6 months. Two-year LRC and overall survival (OS) were 47% and 43%, respectively. Recurrent stage (P=0.005), non-oral cavity subsite (P<0.001), absent organ dysfunction (P<0.001), salvage surgery (P<0.001), and dose >50 Gy (P=0.006) were independently associated with improved LRC. We generated a nomogram with concordance index of 0.68.
  
  
  CONCLUSIONS
  Re-RT can be curative, and our nomogram can help determine a priori which patients may benefit.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, United States.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Riaz
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, United States.
authors.forename: Julian C
authors.initials: JC
authors.lastname: Hong
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, United States.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Sherman
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, United States.
authors.forename: Luc
authors.initials: L
authors.lastname: Morris
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Fury
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, United States.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, United States.
authors.forename: Tony J C
authors.initials: TJ
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Columbia University, New York, United States.
authors.forename: Weji
authors.initials: W
authors.lastname: Shi
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, United States.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Wolden
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, United States.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jackson
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, United States.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wong
authors.affiliation: Department of Radiation Oncology, Columbia University, New York, United States.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, United States.
authors.forename: Shyam D
authors.initials: SD
authors.lastname: Rao
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, United States. Electronic address: leen2@mskcc.org.
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D049451:Nomograms; D016879:Salvage Therapy; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Head and neck cancer; Intensity modulated radiation therapy; Re-irradiation; Recurrent head and neck cancer