Patient Selection and Outcomes in Reirradiation for Head and Neck Cancers: A Prospective Cohort Study

Abstract

Aims

Reirradiation (re-RT) in head and neck cancers requires careful patient selection. This study aimed to identify factors influencing re-RT decisions, analyse survival outcomes, and evaluate toxicities.

Materials and methods

From 2013 to 2017, 250 patients previously treated with radical RT for head and neck cancers were prospectively included. Exclusions were prior RT dose <50 Gy, distant metastasis or prior RT within six months. The median disease-free interval (DFI) was 45.5 months, with a median follow-up of 52 months. Factors affecting survival were analysed, comparing outcomes between re-RT recipients and non-recipients in a propensity score-matched cohort.

Results

Among 250 patients, 177 (70.8%) were advised re-RT. Long DFI (67%) was the most common reason for re-RT, while significant late sequelae (49%) often led to denial. Advanced recurrence stage (HR 1.549, p = 0.04), non-surgical intervention (HR 3.455, p < 0.005), non-recipients of re-RT (HR 4.459, p < 0.005) and organ dysfunction (HR 2.187, p < 0.005) predicted worse survival. For 162 re-RT recipients vs. non-recipients, the 3-year locoregional control, event-free survival and OS were 56.1% vs. 39.9% (p = 0.002), 42.1% vs. 26.7% (p = 0.002), and 57.1% vs. 31.3% (p < 0.001), respectively. After propensity matching, the re-RT group showed better 3-year OS (48.8% vs. 31.3%, p = 0.04) despite increased toxicities.

Conclusion

Effective patient selection is vital for successful re-RT. Surgery followed by adjuvant RT yields optimal outcomes. Despite technical advancements, managing toxicities remains challenging. These findings provide valuable insights for clinicians facing the complex decision of re-RT in head and neck cancer patients.