Re-irradiation in Head and Neck Squamous Cell Carcinoma – A Single Institute Experience

Background: In head and neck squamous cell carcinomas (HNSCC), residual disease, loco regional recurrence or development of second primary are causes of treatment failure. A combination of either surgery or chemotherapy or radiotherapy is used. The aim of this study was to evaluate recurrent/ relapsed HNSCC who were treated with re-irradiation, its toxicities and survival analysis.

Materials and Methods: 72 patients were analysed retrospectively who had undergone re-irradiation at our institute. All patients were histologically proven cases of recurrent/relapsed HNSCC. Treatment was done using conformal radiotherapy techniques like IMRT or IGRT technique.

Results: Patients who had recurrent disease and second primary were 38 (52.8%) and 34 (47.2%) respectively. The time interval between radiotherapy treatments ranged from 7 months to 25 years. Salvage surgery preceded radiotherapy in 16 (22.2%) patients and 56 patients (78.8%) underwent radical radiotherapy. The PTV volume ranged from 15.6 to 672.2 cc (median: 117 cc) and median dose was 54Gy. Mucositis and skin reactions were associated in patients with larger PTV volumes and lower time interval between the radiation treatments. The median DFS and OS was 13 months and 29 months respectively. OS at 1 year and 2 years was 58.3% and 36.1%. Patients who received radiation dose of >54Gy and who had >24 months interval between the radiation treatments fared better.

Conclusions: Treatment approaches have to be personalized in cases of recurrent HNSCC. For re-irradiation in HNSCC we found better outcomes when there is adequate time period (> 24 months) between the radiation treatments and with dose > 54Gy.