title: Re-irradiation for recurrent and second primary cancers of the head and neck.
abstract: To evaluate a single-institutional experience with the use of re-irradiation for recurrent and new primary cancers of the head and neck.
  
  
  
  The medical charts of 80 consecutive patients who underwent re-irradiation for local-regionally recurrent or second primary head and neck cancer between November 1998 and December 2015 were analyzed. Multivariate analysis was performed using Cox proportional hazard and logistic regression to determine predictors of clinical outcomes.
  
  
  
  Seventy-six of the 80 patients were evaluable. The median age was 57.5 (range 26.6-84.9); Intensity-modulated radiotherapy (IMRT) was used in 71 (93.4%) patients with a median dose of 60Gy. Thirty-one patients (40.8%) underwent salvage surgery before re-irradiation and 47 (61.8%) received concurrent systemic therapy. The median time interval between radiation courses was 25.3months (range 2-322months). The 2-year estimates of overall survival, progression free survival, locoregional control, and distant control were 51.0%, 31.3%, 36.8% and 68.3%, respectively. Patients who underwent salvage surgery prior to re-irradiation had significantly improved locoregional control, progression free survival, and overall survival (p<0.05, for all). On multivariate analysis, gross tumor volume (GTV) at re-irradiation and interval between radiation courses were associated with improved overall survival. Severe (grade⩾3) late complications were observed in 25 patients (32.8%).
  
  
  
  Re-irradiation for recurrent or second primary head and neck cancer is feasible and effective in select patients with head and neck cancer. The high observed rate of treatment-related morbidity highlights the continue challenges that accompany this approach.
authors.affiliation: Departments of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, United States.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Velez
authors.affiliation: Departments of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, United States.
authors.forename: Darlene
authors.initials: D
authors.lastname: Veruttipong
authors.affiliation: Departments of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, United States.
authors.forename: Pin-Chieh
authors.initials: PC
authors.lastname: Wang
authors.affiliation: Departments of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Chin
authors.affiliation: Departments of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, United States.
authors.forename: Philip
authors.initials: P
authors.lastname: Beron
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, David Geffen School of Medicine, United States.
authors.forename: Elliot
authors.initials: E
authors.lastname: Abemayor
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, David Geffen School of Medicine, United States.
authors.forename: Maie
authors.initials: M
authors.lastname: St John
authors.affiliation: Departments of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, United States. Electronic address: achen5@kumc.edu.
authors.forename: Allen M
authors.initials: AM
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D016609:Neoplasms, Second Primary / Q000532:radiotherapy*; D050397:Radiotherapy, Intensity-Modulated
keywords: Cancer; Head and neck; Re-irradiation; Recurrent; Second primary