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Abstract
Purpose: The benefits of reirradiation for head and neck cancer (HNC) have not been determined. This study evaluated the efficacy of reirradiation using intensity-modulated radiotherapy (IMRT) for recurrent or second primary HNC (RSPHNC) and identified subgroups for whom reirradiation for RSPHNC is beneficial.

Materials and methods: A total of 118 patients from seven Korean institutions with RSPHNC who underwent IMRT-based reirradiation between 2006 and 2015 were evaluated through retrospective review of medical records. We assessed overall survival (OS) and local control (LC) within the radiotherapy (RT) field following IMRT-based reirradiation. Additionally, the OS curve according to the recursive partitioning analysis (RPA) suggested by the Multi-Institution Reirradiation (MIRI) Collaborative was determined.

Results: At a median follow-up period of 18.5 months, OS at 2 years was 43.1%. In multivariate analysis, primary subsite, recurrent tumor size, interval between RT courses, and salvage surgery were associated with OS. With regard to the MIRI RPA model, the class I subgroup had a significantly higher OS than class II or III subgroups. LC at 2 years was 53.5%. Multivariate analyses revealed that both intervals between RT courses and salvage surgery were prognostic factors affecting LC. Grade 3 or more toxicity and grade 5 toxicity rates were 8.5% and 0.8%, respectively.

Conclusion: IMRT-based reirradiation was an effective therapeutic option for patients with RSPHNC, especially those with resectable tumors and a long interval between RT courses. Further, our patients' population validated the MIRI RPA classification by showing the difference of OS according to MIRI RPA class.

Affiliations

Jeongshim Lee  1 , Tae Hyung Kim  2 , Yeon-Sil Kim  3 , Myungsoo Kim  4 , Jae Won Park  5 , Sung Hyun Kim  6 , Hyun Ju Kim  7 , Chang Geol Lee  2
1 Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
2 Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
3 Department of Radiation Oncology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
4 Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
5 Department of Radiation Oncology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.
6 Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
7 Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Korea.