Personalized Care: Study highlights which patients would benefit from a second round of chemoradiation

Balancing the risks and benefits of concurrent reirradiation and chemotherapy for recurrent head and neck cancers is difficult for physicians at even the most experienced centers. Research recently published in Cancer, however, suggests that selection of patients who may benefit from this therapy should be based on the patient’s previous treatment and the amount of time that has elapsed since initial treatment (Choe KS, Haraf DJ, Solanki A. [Published online ahead of print June 13, 2011.]

Patients being considered for reirradiation start with a poor prognosis, said Douglas Frank, MD, chief of the division of head and neck surgery at Long Island Jewish Medical Center and associate professor in the department of otolaryngology-head and neck surgery at Albert Einstein College of Medicine in New York. “What we struggle with as clinicians is that we know that there is somewhat of a desperation to it,” he said. “We have to be very judicious in offering this type of treatment, knowing which patients are least likely to benefit and who will have the most complications.”

The retrospective study, conducted at the University of Chicago, included data from nine consecutive phase 1 and 2 protocols with 166 patients who had recurrent or second primary squamous cell carcinoma in a region that had previously been irradiated. Eighty-one of the patients had had surgical resection or de-bulking before enrollment. All patients received reirradiation as well as concurrent chemotherapy, which generally comprised 5-fluorouracil, hydroxyurea and a third agent. After a median follow-up of 53 months, median overall survival (OS) was 10.3 months. The two-year OS rate was 24.8 percent.