Re-irradiation versus Chemo-reirradiation for Recurrent,Unresectable Head and Neck Cancer

Abstract

Objectives:

Both chemo-reirradiation and reirradiation alone have been shown to be feasible treatment options for recurrent, unresectable head and neck cancer in an irradiated field. However, no randomized controlled studies have been performed to compare their efficacy. Our goal was to compare the survival and toxicity rates among patients treated with chemo-reirradiation and reirradiation.

Methods:

A Pubmed search was performed using the search terms: re irradiation, previously irradiated, reirradiation, re-irradiation and head and neck neoplasms[Mesh]. Two observers identified the full manuscripts which fulfilled the inclusion criteria: recurrent or second primary head and neck cancer, prior irradiation, no surgery, and no targeted therapy. Median overall survival (OS), 1-year OS, and toxicity between reirradiation alone and chemo-reirradiation groups were compared using Mann-Whitney-U test.

Results:

Of 473 papers identified, 15 papers were included: 11 papers (n = 567) reported median OS, and 13 papers (n = 601) reported 1-year OS. Median age of the patients and radiation dosage delivered were similar between the groups. Average 1-year OS was 44.1% (n = 214) in the reirradiation group and 47.2% (n = 387) in the chemo-reirradiation group (P = 0.42). Average median OS was 12 months in the reirradiation group (n = 162) and 10.6 months in the chemo-reirradiation group (n = 405) (P = 0.32). Average incidence of Grade-3/4 Mucositis was 21.5% (n = 118) in the reirradiation group and 18.1% (n = 396) in the chemo-reirradiation group (P =0.46). Chemotherapy-related-hematology toxicity was 24.2% (n = 353).

Conclusions:

This analysis involving more than 600 patients shows that, compared to reirradiation alone, chemo-reirradiation has no discernable difference in OS or local toxicity but poses additional hematological toxicity. Optimal treatment remains to be defined.