Survival for patients with head and neck cancer was improved with aggressive proton therapy reirradiation (PT-ReRT), according to study results published in JAMA Network Open.

Increasingly, patients with head and neck cancer recurrence are treated with PT-ReRT because it limits dose exposure to normal tissues outside the treatment field.

This retrospective cohort study was designed to evaluate outcomes of PT-ReRT for the treatment of head and neck squamous cell carcinoma (HNSCC). The researchers evaluated 242 patient records from Memorial Sloan Kettering Cancer Center between 2013 and 2020.

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The patients were median age 63 years (range, 21 to 96), 75.6% were men, 95.9% had a Karnofsky Performance Status (KPS) score of 70 or higher, and 59.9% had at least a 10-pack-year smoking history.

The most common dosing sites were lip and oral cavity (37.6%), oropharynx (26.4%), and skin (11.2%). Most patients (87.6%) had locoregional disease.

Median follow-up was 18 months overall and 25 months for survivors. The patients received a median of 3 cycles with reirradiation doses of 70 cobalt gray equivalents (CGE) for fractionated treatment and 44.4 CGE for quad-shot treatment.

There were 73 grade 3 and 6 grade 4 early toxic effects and 79 grade 3 and 9 grade 4 late toxic effects.

One-year survival rates were 66.6% for fractionated treatment and 28.5% for quad-shot treatment.

Overall survival was improved with salvage surgery (HR, 0.57; P =.005) and KPS score 70 or higher (HR, 0.50; P =.046) and poorer with quad-shot treatment (HR, 1.97; P <.001).

Limitations of this study included its nonrandomized and retrospective study design.

“This cohort study found that patients treated with proton therapy in a previously irradiated area of the head and neck may live longer compared with those receiving historical photon-based reirradiation,” the study authors concluded.

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Lee A, Woods R, Mahfouz A, et al. Evaluation of proton therapy reirradiation for patients with recurrent head and neck squamous cell carcinoma. JAMA Netw Open. 2023;6(1):e2250607. doi:10.1001/jamanetworkopen.2022.50607