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Tim A. Iseli, MBBS; Claire E. Iseli, MBBS, MS; Eben L. Rosenthal, MD; Jimmy J. Caudell, MD, PhD; Sharon A. Spencer, MD; J. Scott Magnuson, MD; Angelia N. Smith, BSc; William R. Carroll, MD

Arch Otolaryngol Head Neck Surg. 2009;135(11):1158-1164.

Objectives  To compare toxic effects and functional outcomes of reirradiation with and without salvage surgery for nonnasopharyngeal mucosal head and neck squamous cell carcinoma.

Design  Retrospective review.

Setting  Academic tertiary referral hospital.

Patients  Between December 1992 and March 2007, a total of 87 patients underwent reirradiation (64 for cure and 23 for palliation).

Intervention  Patients underwent reirradiation with (n = 38) or without salvage surgery (n = 49). After January 2000 there was increased use of concurrent platinum-based chemotherapy (80% vs 5%) and intensity-modulated radiation therapy (82% vs 0%).

Main Outcome Measures  Early and late toxic effects of treatment by Radiation Therapy Oncology Group criteria, tracheostomy retention, gastrostomy tube dependence, and survival.

Results  The median follow-up among patients alive at last contact was 5.0 years. Compared with reirradiation without surgery, postoperative reirradiation was associated with increased early grade 3 to grade 5 toxic effects (50% [19 of 38] vs 29% [14 of 49], P = .04) and with longer median survival (17.3 vs 8.9 months, P < .001). Free-flap reconstruction decreased early toxic effects in the surgical cohort by 16% (from 60% [9 of 15] to 43% [10 of 23], P = .32). Gastrostomy tube dependence (P = .05) and tracheostomy retention (P = .04) have increased since 2000. The median survival for curative patients was 12.5 months. The estimated 2-year survival was 25%, and the estimated 5-year survival was 8%.

Conclusions  Reirradiation represents the only chance for cure in patients with unresectable disease. After surgery, reirradiation is performed in patients at high risk of locoregional recurrence and may increase acute toxic effects. However, free-flap reconstruction may reduce toxic effects. Functional outcomes have declined since 2000 likely because of the addition of concurrent platinum-based chemotherapy. Future research may define the subpopulation of postoperative patients for whom survival benefits most outweigh reirradiation toxic effects.

Author Affiliations: Division of Otolaryngology–Head and Neck Surgery, Department of Surgery (Drs T. A. Iseli, C. E. Iseli, Rosenthal, Magnuson, and Carroll and Ms Smith), and Department of Radiation Oncology (Drs Caudell and Spencer), University of Alabama at Birmingham; and Department of Otolaryngology–Head and Neck Surgery, Monash Medical Centre, Clayton, Victoria, Australia (Dr C. E. Iseli).

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