Challenges in recurrent head and neck squamous cell cancer treatment: systematic review and meta-analysis comparing efficacy and toxicity between post-operative and definitive IMRT-based reirradiation

TL;DR

This study finds that post-operative IMRT provides better survival and tumor control than definitive IMRT for recurrent head and neck cancer.

Contribution

A systematic review and meta-analysis comparing post-operative and definitive IMRT for reirradiation in recurrent head and neck cancer.

Findings

Post-operative IMRT showed 68% 1-year overall survival versus 55% for definitive IMRT.

Post-operative IMRT achieved 65% 1-year locoregional control compared to 58% for definitive IMRT.

The certainty of findings was low due to limitations in the included studies.

Abstract

•A meta-analysis comparing post-operative and definitive IMRT for HNSCC reirradiation.•The results of 10 studies with 958 patients are included.•1-year overall survival is superior after post-operative IMRT.•1-year locoregional control is likewise superior after post-operative IMRT.

A meta-analysis comparing post-operative and definitive IMRT for HNSCC reirradiation.

The results of 10 studies with 958 patients are included.

1-year overall survival is superior after post-operative IMRT.

1-year locoregional control is likewise superior after post-operative IMRT.

Treatment of patients with recurrent head and neck squamous cell cancer in a previously irradiated field remains challenging. We performed a meta-analysis, comparing the efficacy and safety of definitive and post-operative intensity-modulated radiotherapy (IMRT) based reirradiation.

MEDLINE, Cochrane Library, Web of Science, SCOPUS and PsycINFO were systematically searched. The Newcastle-Ottawa Scale was used to assess the risk of bias. A meta-analysis was performed using the random-effects model.

10 eligible studies with a median follow up of 24.9 months (9.6–78.1) and a total of 958 patients were identified, two of which are prospective trials. 455 were patients treated with post-operative/ adjuvant IMRT (aIMRT), while 503 patients received definitive IMRT (dIMRT). Median age was 62 years (48–63), 78 % were males and the rate of concomitant systemic therapy varied between 0 and 100 %.

Post-operative IMRT showed significantly higher 1-year overall survival of 68 %, compared to 55 % for dIMRT, with a risk reduction (RR) of 0.84 (95 % CI: 0.76–0.93). aIMRT achieved superior 1-year locoregional control (65 %) in comparison to dIMRT (58 %) with an RR of 0.89 (95 % CI: 0.798 to 0.997). All other endpoints did not reach statistical significance. The certainty of our findings was low, due to limitations in the included studies. Radiotoxicity was insufficiently reported and does not allow any conclusions.

Post-operative IMRT achieves superior survival and tumor control and should be the preferred option for patients eligible for surgery. Careful patient evaluation and selection are fundamental to maximizing therapeutic efficacy while minimizing treatment-related toxicities.

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