Loco-regional failures in head and neck cancer: can they be effectively salvaged by nonsurgical therapeutic modalities?

Abstract.

Background: This retrospective study was carried out to ascertain the extent of efficacy of nonsurgical salvage modalities, mainly chemotherapy (CT) alone or chemoradiotherapy (CTRT), for loco-regional failures in head and neck cancer (HNC).

Methods: Between 1991 and 1999, 131 patients with HNC, mostly stages III and IV, who had loco-regional residual (n = 78) or recurrent lesions (n = 53) following curative therapy with either radiotherapy (RT), neoadjuvant CT (NACT) followed by RT, or concurrent CTRT were included in this analysis. Of these, 84 patients (residual, 58; recurrent, 26), did not receive any form of salvage therapy, while 47 had either CT alone (n = 22) or CTRT (n = 25). Endpoints evaluated were: loco-regional response (LRR), post-salvage survival (PS), overall survival (OS), and normal tissue acute and late morbidities.

Results: Salvage therapy enabled a LRR in 46.8% of the patients. Both OS and PS were also significantly better for those who received salvage therapy (P < 0.001). CTRT appears to offer significantly better salvage than CT alone for all the evaluated endpoints. Multivariate analysis for LRR, PS, and OS consistently showed the salvage RT dose to be a significant predictor. Early and late effects of salvage therapy were not influenced by either the salvage or total RT doses.

Conclusion: Loco-regional failures in advanced HNC can be effectively salvaged by CTRT to significantly prolong OS and PS. However, to achieve an optimum therapeutic ratio, the choice of drugs, their schedule, and the RT dose need to be defined through randomized trials.