Study reveals factors in treating recurrent head, neck cancers

By Debbie Bolles

New research by UT Southwestern Medical Center scientists has identified important factors that may indicate which head and neck cancer patients stand a better chance of survival after a second round of radiation and chemotherapy.

Chemotherapy and a second course of radiation, known as reirradiation, often is the only curative treatment option when head and neck cancer recurs. But this treatment might be associated with potentially life-threatening side effects. For that reason, researchers involved in the investigation set out to pinpoint which patients would be best suited for reirradiation – and which patients might face too big a risk.

Kevin Choe, MD

“The goal of our study was to determine what important factors we can use to identify patients who will benefit the most from such aggressive therapy, even if there is high toxicity,” said Dr. Kevin Choe, Assistant Professor of Radiation Oncology and lead author of the study published recently in the journal Cancer.

Head and neck cancers include cancers of the mouth, throat, and sinuses. These account for about 40,000 new cases nationwide each year, according to the National Cancer Institute.

In collaboration with colleagues at Duke Cancer Institute and the University of Chicago, Dr. Choe analyzed data involving 166 head and neck cancer patients treated with both radiation and chemotherapy when their cancer recurred. All had been treated with radiation when their cancer first developed.

Among the factors found in the patients who fared better:

  • Initial treatment involved radiation alone rather than with chemotherapy.
  • The remission period was three years or more before cancer returned.
  • Radiation doses were at fullest strength.
  • The patient had surgery to remove part or all of the new cancer.

For patients who had all four of the favorable factors, the two-year survival rate was 64 percent. There were no survivors at two years without at least one of the factors.

Patients who had radiation plus chemotherapy when the cancer first arose commonly had more negative outcomes. This combination treatment is usually recommended for newly diagnosed head and neck cancer patients who are not good candidates for surgery.

“We still believe radiation administered along with chemotherapy is an appropriate and effective treatment for newly diagnosed head and neck cancer, but we have to be mindful that when we are considering second-time treatment, these patients may not benefit as much from reirradiation. We need to develop a better way to treat them,” said Dr. Choe, who was awarded a 2011 Distinguished Researcher Award from the President’s Research Council at UT Southwestern.

Many head and neck cancers are linked to smoking and use of chewing tobacco. This type of cancer returns about 30 percent of the time after the initial therapy.