A small group of patients with recurrent or second primary head and neck cancer achieved long-term cure after undergoing concomitant chemotherapy with reirradiation. However, the associated risk of severe toxicity demonstrated that only carefully selected patients should undergo treatment readministration.    

Joseph Salama, MD, formerly with the University of Chicago (Illinois), and colleagues analyzed data from 166 patients with head and neck cancer who had received a first round of radiation followed by a second round plus chemotherapy because their cancer recurred or because they developed a new tumor. After a median follow-up of 53 months among surviving patients, median overall survival was 10.3 months. The 2-year rates for overall survival, disease-free survival, locoregional control, and freedom from distant metastasis were 24.8%, 19.9%, 50.7%, and 61.4%, respectively.

Despite yielding a 2-year cure rate of nearly a quarter of the subjects, the second course of treatment was highly toxic: 33 participants (19.9%) died of treatment-related toxicity, and some lost the ability to speak or swallow. The investigators found that certain patients benefited from the second treatment over others: Those who were cancer-free for a longer period of time, did not have chemotherapy with their first course of radiation, were treated with a higher dose of radiation in their second round, and had surgical resection or debulking prior to the second course of radiation were more likely to be cured at 2 years than those who had none or only some of these features.

“This can help doctors determine which patients are best suited for a second course of radiation with chemotherapy for head and neck cancer,” observed Salama in a statement announcing the study findings, which were published online ahead of print by the journal Cancer.