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

作者：Riaz Nadeem; Hong Julian C; Sherman Eric J; Morris Luc; Fury Matthew; Ganly Ian; Wang Tony J C; Shi Weji; Wolden Suzanne L; Jackson Andrew; Wong Richard J; Zhang Zhigang; Rao Shyam D; Lee Nancy Y^*

来源：Radiotherapy and Oncology, 2014, 111(3): 382-387.

DOI：10.1016/j.radonc.2014.06.003

• Re-irradiation
• Head and neck cancer
• Intensity modulated radiation therapy
• Recurrent head and neck cancer

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 dysP < 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 deteimine a priori which patients may benefit.

• 出版日期2014-6