Optimising (re-)irradiation for locally recurrent head and neck cancer: impact of dose-escalation, salvage surgery, PEG tube and biomarkers on oncological outcomes-a single centre analysis.

Introduction: Locoregional recurrence (LR) is common in locally advanced head and neck cancer (HNSCC), posing challenges for treatment. We analysed outcome parameters and toxicities for patients being treated with radiotherapy (RT) for LR-HNSCC and investigated patient and disease related prognostic factors in this prognostically unfavourable group.
Methods: This analysis includes 101 LR-HNSCC patients treated with RT, radio-chemotherapy (RCT) or radio-immunotherapy (RIT) between 2010 and 2018 at a high-volume tertiary centre. Patient characteristics, tumour and treatment details were retrospectively collected. Overall survival (OS), progression-free survival (PFS) and toxicities according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0 were assessed.
Results: 62% of patients were radiotherapy-naïve (initial RT group) while 38% were re-irradiated at site of LR (re-RT group). Median OS for initial RT was 24 months, for re-RT 12 months (p < 0.01). In the RCT subgroup, patients with initial RT had significantly longer OS with 35 months compared to re-RT 12 months (p < 0.05). Patients with UICC grade IV tumours and percutaneous endoscopic gastrostomy (PEG) tube had significantly shorter OS in multivariate analysis: initial RT 13 vs. re-RT 32 months and initial RT 12 vs. re-RT 32 months respectively. Salvage surgery before RT at recurrence was a positive prognostic factor for OS (initial RT 35 vs. re-RT 12 months). Other significant factors for longer OS in univariate analysis included low inflammatory status (Glasgow Prognostic Score 0) and radiation doses ≥ 50 Gy. We detected 37 (15%) ≥ CTCAE Grade 3 events for initial RT and 19 (15%) for re-RT patients.
Conclusion: In this analysis, we identified key prognostic factors including PEG tube and inflammation status that could guide treatment decision. Our findings suggest salvage surgery as preferred treatment option with postoperative RT at LR. Adverse events due to re-RT were acceptable. A radiation dose of ≥ 50 Gy should be administered to achieve better outcomes.
Competing Interests: Declarations. Human ethics: The study was approved by the ethics committee of the University Hospital of Cologne (number 20-1108). Consent to participate: According to §10 section (9) of the German Data Protection Act (DSG), the storage or use of personal (in this case patient-related) data is permissible if it is necessary for the conduct of scientific research and the scientific interest in carrying out the research project substantially outweighs the interest of the individual concerned, as well as the research purpose cannot be achieved in any other way or can only be achieved at disproportionate expense. Since this retrospective study only includes patients recurrent head and neck cancer who were treated until July 2018, it can be assumed that, given the poor prognosis or short survival time of the patients, it will not be possible to subsequently obtain the consent of the patients for the study-related analysis of their data, or only at disproportionate expense. In contrast, the research topic offers the possibility to evaluate the Optimization of (Re-)Irradiation for Locally Recurrent Head and Neck Cancer and their prognostic significance, which may provide important information for subsequent and individualized therapeutic options for the patients. Only patient data that were available by 31 December 2019 will be collected, so there will be no direct or indirect cost or harm to patients. The data to be analysed in this study is retrospective data only and has been collected and analysed anonymously. Prospective. data sets have not been collected. Clinical Trial number: Not applicable. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)