A retrospective study of head and neck re-irradiation for patients with recurrent or second primary head and neck cancer: the McGill University experience.
BACKGROUND
We report our experience with patients who received re-irradiation to the head and neck area for locoregional recurrences (LRR) or second primaries (SP) in a previously irradiated field.


METHODS
We reviewed 27 consecutive patients with a diagnosis of LRR or SP head and neck carcinoma treated with a second course of radiotherapy between April 2004 and July 2012. The main outcome measures were local control, overall survival, and complications. The results are expressed as actuarial values using the Kaplan-Meier estimates.


RESULTS
The median follow-up time was 24.7 months (range: 11 days-79.3 months). There were 23 males and four females with a median age of 61 years (range: 40-87 years). The actuarial overall survival rates at 1, 2, and 5 years were 77, 59, and 57%, respectively. The actuarial local control rate was 80, 52, and 52% at 1, 2, and 5 years, respectively. Three patients developed systemic metastases. The rate of grade 3 toxicity was 26%, and that of grade 4 toxicity was 3%. There were two treatment-related deaths (grade 5 toxicity).


CONCLUSIONS
Continuous course re-irradiation in patients with LRR or SP head and neck cancer is feasible with acceptable toxicity. With current encouraging rates of local control and overall survival, this option should be discussed with patients who have few alternative therapeutic options.
Department of Radiation Oncology, King Abdulaziz University, Abdullah Suleiman Street, P.O Box 80200, 21589, Jeddah, Saudi Arabia. ralwassia@kau.edu.sa.
Rolina
R
Al-Wassia
Department of Radiation Oncology, McGill University Health Centre, McGill University, Montreal, Québec, Canada. siavosh.vakilian@mail.mcgill.ca.
Siavosh
S
Vakilian
Department of Clinical Epidemiology, McGill University, Montreal, Québec, Canada. crystal.holly@gmail.com.
Crystal
C
Holly
Radiation Oncology, Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Québec, Canada. ksultane@roc.jgh.mcgill.ca.
Khalil
K
Sultanem
Department of Radiation Oncology, McGill University Health Centre, McGill University, Montreal, Québec, Canada. george.shenouda@muhc.mcgill.ca.
George
G
Shenouda
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D009367:Neoplasm Staging / Q000379:methods*; D016609:Neoplasms, Second Primary; D049268:Positron-Emission Tomography; D011792:Quebec / Q000453:epidemiology; D000069475:Re-Irradiation / Q000379:methods*; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014495:Universities