Validation of Nomogram-based Prediction of Survival Probability after Salvage Re-irradiation of Head and Neck Cancer

Author： Shikama Naoto Kumazaki Yu Tsukamoto Nobuhiro Ebara Takeshi Makino Soichi Abe Takanori Nakahira Mitsuhiko Sugasawa Masashi Kato Shingo

Publisher： Oxford University Press

ISSN： 1465-3621

Source： Japanese Journal of Clinical Oncology, Vol.43, Iss.2, 2013-02, pp. : 154-160

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Abstract

ObjectiveTreatment outcomes after salvage re-irradiation in patients with recurrent head and neck cancer vary widely due to heterogeneous patient characteristics, and it is difficult to evaluate optimal re-irradiation schedules. This study aimed to validate a nomogram, originally developed by Tanvetyanon et al., used to predict the survival probability of patients with recurrent head and neck cancer after re-irradiation.MethodsTwenty-eight patients with recurrent head and neck cancer who underwent salvage re-irradiation between June 2007 and November 2011 were evaluated. The median total dose used for initial radiotherapy was 60 Gy (range, 22-72). Re-irradiation sites included the nasopharynx or Rouviere's node (n = 14), external ear (n = 4), neck lymph node (n = 3) and other sites (n = 7). Overall survival after re-irradiation was calculated using the Kaplan-Meier method, and the 2-year survival probability was estimated using Tanvetyanon's nomogram.ResultsTwenty-two patients were treated with stereotactic body radiotherapy using a median total dose of 30 Gy (range, 15-40) in 1-7 fractions and six patients were treated with conventional external beam radiotherapy using 45 Gy (range, 23.4-60) in 10-30 fractions. The 2-year overall survival was 21.7% (95% confidence interval: 9.3-41.3), and the 2-year survival probability was 16.8% (95% confidence interval: 9.9-23.6). The 2-year overall survival in 20 patients with unfavorable prognosis (median 2-year survival probability, 5.5%) and in 8 patients with favorable prognosis (median 2-year survival probability, 45%) were 11.0 and 45.7%, respectively (P = 0.05).ConclusionsOur findings show that Tanvetyanon's nomogram accurately estimates the survival probability in patients with recurrent head and neck cancer after re-irradiation.