title: Outcomes of patients with loco-regionally recurrent or new primary squamous cell carcinomas of the head and neck treated with curative intent reirradiation at Mayo Clinic.
abstract: BACKGROUND
  We reviewed outcomes of patients with loco-regionally recurrent (LRR) or new primary (NP) squamous cell carcinoma of the head and neck (SCCHN) treated at our institution with reirradiation (RRT).
  
  
  METHODS
  Patients received definitive RRT (DRRT) or post-operative RRT following salvage surgery (PRRT) from 2003 to 2011. Measured survival outcomes included loco-regional relapse free survival (LRFS) and overall survival (OS).
  
  
  RESULTS
  Among 81 patients (PRRT, 42; DRRT, 39), median PRRT and DRRT doses were 60 Gy (12-70 Gy) and 69.6 Gy (48-76.8 Gy). The majority of patients received IMRT-based RRT (n = 77, 95 %). With median follow-up of 78.1 months (95 % CI, 56-96.8 months), 2-year OS was 53 % with PRRT and 48 % with DRRT (p = 0.12); 23 % of patients were alive at last follow-up. LRFS at 2 years was 60 %, and did not differ significantly between PRRT and DRRT groups. A trend toward inferior LRFS was noted among patients receiving chemotherapy with RRT versus RRT alone (p = 0.06). Late serious toxicities were uncommon, including osteoradionecrosis (2 patients) and carotid artery bleeding (1 patient, non-fatal).
  
  
  CONCLUSIONS
  OS of PRRT- and DRRT-treated patients in this series appears superior to the published literature. We used IMRT for the majority of patients, in contrast to several series and trials previously reported, which may account in part for this difference. Future studies should seek to improve outcomes among patients with LRR/NP SCCHN via alternative therapeutic modalities such as proton radiotherapy and by incorporating novel systemic agents.
authors.affiliation: Department of Internal Medicine, Division of Hematology/Medical Oncology, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA. Curtis.kelly1@mayo.edu.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Curtis
authors.affiliation: Department of Internal Medicine, Division of Hematology/Medical Oncology, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA.
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Ross
authors.affiliation: Department of Internal Medicine, Division of Hematology/Medical Oncology, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Garrett
authors.affiliation: Department of Internal Medicine, Division of Hematology/Medical Oncology, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ, 85259, USA.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Jizba
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Ajay B
authors.initials: AB
authors.lastname: Patel
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Samir H
authors.initials: SH
authors.lastname: Patel
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Wong
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Michele Y
authors.initials: MY
authors.lastname: Halyard
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ko
authors.affiliation: Department of Biomedical Statistics, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Kosiorek
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Foote
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000532:radiotherapy*; D016016:Proportional Hazards Models; D011829:Radiation Dosage; D011874:Radiometry; D011878:Radiotherapy / Q000379:methods; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D000069475:Re-Irradiation / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome
keywords: Recurrent squamous cell carcinoma head and neck; Reirradiation; Survival outcomes; Toxicity