Chemo-reirradiation in persistent/recurrent head and neck cancers

This retrospective study was carried out to evaluate the feasibility and safety of chemo-reirradiation as a salvage treatment in patients with persistent/recurrent head and neck cancers. From 1991 to 1999, records of 131 patients with head and neck carcinoma who had loco-regional persistent/recurrent disease following curative therapy were analyzed. Of these, 33 patients had received chemo-reirradiation. Four patients were further excluded as they had been reirradiated by brachytherapy or external radiotherapy (RT) alone. The remaining 29 patients received reirradiation along with chemotherapy. They were evaluated for toxicity profile, post-salvage survival and overall survival. The median reirradiation dose was 34 Gy (range, 12-50 Gy) and median cumulative RT dose was 104 Gy (range, 72-124 Gy). The median for chemotherapy cycles was four. Grade 2/3 mucositis, dermatitis, neutropenia were seen in 10%, 7% and 3% of patients, respectively. An overall response rate was seen in 83% of patients with complete response in 31%. All complete responders had received a cumulative RT dose of ≥100 Gy. Those patients who were initially treated by external radiation alone benefited with subsequent chemo-reirradiation with a complete response rate of 54%. The median post-salvage overall survival was 9 months with the 1- and 2-year survival rates being 41% and 12%, respectively. The post-salvage disease free survival (P=0.01) and overall survival (P=0.008) were also significantly better in patients who were treated initially by external RT alone. Chemo-reirradiation appears feasible and effective in patients treated previously with external RT but needs proper patient selection. Patients should be given optimum reirradiation dose, with cumulative doses of ≥100 Gy, along with chemotherapy. This study warrants the need for more prospective trials. (author)