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. 2014 Jun;111(3):382-7.
doi: 10.1016/j.radonc.2014.06.003. Epub 2014 Jun 30.

A nomogram to predict loco-regional control after re-irradiation for head and neck cancer

Nadeem Riaz  1 , Julian C Hong  1 , Eric J Sherman  2 , Luc Morris  3 , Matthew Fury  2 , Ian Ganly  3 , Tony J C Wang  4 , Weji Shi  5 , Suzanne L Wolden  1 , Andrew Jackson  1 , Richard J Wong  3 , Zhigang Zhang  5 , Shyam D Rao  1 , Nancy Y Lee  6
Affiliations

A nomogram to predict loco-regional control after re-irradiation for head and neck cancer

Nadeem Riaz et al. Radiother Oncol. 2014 Jun.

Abstract

Background and purpose: Loco-regionally recurrent head and neck cancer (HNC) in the setting of prior radiotherapy carries significant morbidity and mortality. The role of re-irradiation (re-RT) remains unclear due to toxicity. We determined prognostic factors for loco-regional control (LRC) and formulated a nomogram to help clinicians select re-RT candidates.

Material and methods: From July 1996 to April 2011, 257 patients with recurrent HNC underwent fractionated re-RT. Median prior dose was 65 Gy and median time between RT was 32.4 months. One hundred fifteen patients (44%) had salvage surgery and 172 (67%) received concurrent chemotherapy. Median re-RT dose was 59.4 Gy and 201 (78%) patients received IMRT. Multivariate Cox proportional hazards were used to identify independent predictors of LRC and a nomogram for 2-year LRC was constructed.

Results: Median follow-up was 32.6 months. Two-year LRC and overall survival (OS) were 47% and 43%, respectively. Recurrent stage (P=0.005), non-oral cavity subsite (P<0.001), absent organ dysfunction (P<0.001), salvage surgery (P<0.001), and dose >50 Gy (P=0.006) were independently associated with improved LRC. We generated a nomogram with concordance index of 0.68.

Conclusion: Re-RT can be curative, and our nomogram can help determine a priori which patients may benefit.

Keywords: Head and neck cancer; Intensity modulated radiation therapy; Re-irradiation; Recurrent head and neck cancer.

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Conflict of interest statement

There are no financial disclosures from any authors.

Figures

Fig. 1
Fig. 1
Median loco-regional control was 16.8 months.
Fig. 2
Fig. 2
Median overall survival was 17.3 months.
Fig. 3
Fig. 3
The Nomogram predicts 2-year probability of loco-regional control (LRC) after re-irradiation. Stage is at time of recurrence. Organ dysfunction is defined as patients requiring feeding tube or tracheostomy, or those with soft-tissue defect, fistula, or osteonecrosis. Surgery indicates those patients who underwent surgical salvage. Radiation therapy (RT) dose indicates those who received greater than 50 Gy and/or can receive a brachytherapy boost.
See this image and copyright information in PMC

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