A nomogram to predict loco-regional control after re-irradiation for head and neck cancer

Nadeem Riaz, Julian C. Hong, Eric J. Sherman, Luc Morris, Matthew Fury, Ian Ganly, Tony J.C. Wang, Weji Shi, Suzanne L. Wolden, Andrew Jackson, Richard J. Wong, Zhigang Zhang, Shyam Rao, Nancy Y. Lee

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


Background and purpose Loco-regionally recurrent head and neck cancer (HNC) in the setting of prior radiotherapy carries significant morbidity and mortality. The role of re-irradiation (re-RT) remains unclear due to toxicity. We determined prognostic factors for loco-regional control (LRC) and formulated a nomogram to help clinicians select re-RT candidates. Material and methods From July 1996 to April 2011, 257 patients with recurrent HNC underwent fractionated re-RT. Median prior dose was 65 Gy and median time between RT was 32.4 months. One hundred fifteen patients (44%) had salvage surgery and 172 (67%) received concurrent chemotherapy. Median re-RT dose was 59.4 Gy and 201 (78%) patients received IMRT. Multivariate Cox proportional hazards were used to identify independent predictors of LRC and a nomogram for 2-year LRC was constructed. Results Median follow-up was 32.6 months. Two-year LRC and overall survival (OS) were 47% and 43%, respectively. Recurrent stage (P = 0.005), non-oral cavity subsite (P < 0.001), absent organ dysfunction (P < 0.001), salvage surgery (P < 0.001), and dose >50 Gy (P = 0.006) were independently associated with improved LRC. We generated a nomogram with concordance index of 0.68. Conclusion Re-RT can be curative, and our nomogram can help determine a priori which patients may benefit.

Original languageEnglish (US)
Pages (from-to)382-387
Number of pages6
JournalRadiotherapy and Oncology
Issue number3
StatePublished - Jan 1 2014
Externally publishedYes


  • Head and neck cancer
  • Intensity modulated radiation therapy
  • Re-irradiation
  • Recurrent head and neck cancer

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging


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