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

Research reported by Goodwin in 2000 found that salvage surgery came at great cost to patients (Laryngoscope. 2000;110(suppl 93):1-18). Following salvage surgery, the researchers found that about 33 percent of people with stage III recurrent cancer lived at least two years, but 30 percent had significant complications, and fewer than 25 percent of patients with stage IV recurrent cancer lived for at least two years, and 30 percent had significant complications. In patients with stages I and II recurrent cancer, the results of salvage surgery were better: They had a 70 percent chance of living for at least two years without recurrence of their cancer and a 60 percent to 85 percent change of a successful outcome with respect to their quality of life.

Dr. Schwartz’s research has looked at using intensity-modulated radiotherapy (IMRT) as reirradiation therapy for patients with recurrent or second primary head and neck cancers (Int J Radiat Oncol Biol Phys. 2009;73(2):399-409). In that study, data from 78 consecutive patients reirradiated with IMRT for recurrent head and neck cancer were reviewed. Median time interval between the initial radiation and reirradiation was 46 months, and median reirradiation dose was 60 Gy. The two-year OS rate was 58 percent, and the locoregional control rate was 64 percent. Twenty percent of the patients had severe reirradiation-related toxicity.

Because prognosis is poor, the balance between risks and benefits is complex and ability to select patients is limited. Patients undergoing treatment for recurrent cancer should, in an ideal world, be treated in a clinical trial, Dr. Fury said. “When you look at the studies, the probability of getting meaningful disease-free survival is the same as the probability of dying from toxicity of treatment,” he added. “That gives us pause.”

One outcome of this research, according to Dr. Frank, is that physicians have more information for open discussions with their patients. “There has been great interest in the past few years about reirradiation, and that’s a very difficult discussion to have with patients,” he said. “It’s extremely morbid. For the patient who is not resectable and has been treated previously with chemoradiation, this allows us to present a more honest discussion about treatment. Maybe, some of those patients would opt instead for something more palliative or [for] pain hospice care.” ENT TODAY