Dr. Koyfman on Risk Categories in the Reirradiation Setting of Recurrent Head and Neck Cancer

Shlomo Koyfman, MD, associate staff, Radiation Oncology, Cleveland Clinic, discusses risk categories that stratified patients in a study evaluating intensity-modulated radiation therapy and stereotactic body radiation therapy to determine outcomes in the reirradiation setting for recurrent head and neck cancer.

An important patient factor assessed in this study was the time it took for a patient to either be diagnosed with a second head and neck cancer or to experience recurrence. If this happened after a 2-year period from the patient's first radiation treatment, it was automatically considered to have a better prognosis.

Of those patients, says Koyfman, if their cancer was removed through surgery and postoperative reirradiation was needed, the 2-year survival was 60%.

On the other hand, the poorer performing patients, whose cancers returned within the 2-year time period or patients were diagnosed with a new cancer in that time, they often had impaired function caused by either prior treatments or their tumors. With the same reirradiation treatment as the better performing patients, this group's 2-year survival was only 16%.

According to Koyfman, these results essentially have oncologists' minds racing to determine which patients should receive more aggressive or risky interventions, and which patients would benefit more from a focus on quality of life. These findings serve to potentially define new standards of care in head and neck cancer, and to assist in the overall decision-making process for patients and physicians.