Postoperative radiation therapy for primary vs. recurrent squamous cell carcinoma of the head and neck: Results of a comparative analysis

Background. There is little literature comparatively evaluating the results of postoperative radiation therapy (RT) for patients with squamous cell carcinoma (SCC) of the head and neck treated for primary versus recurrent disease. Methods. Between 1981 and 1993, 174 patients with SCC of the head and neck, 143 with primary and 31 with recurrent disease, were treated with standard postoperative RT. Results. Patients treated for primary disease had 5-year local-regional control (LRC) and disease-specific survival (DSS) rates of 69% and 54%, respectively, as compared with 46% and 32%, respectively, for patients treated for recurrent disease (P = 0.03 and 0.04, respectively). On multivariate analysis, only tumor type (primary vs recurrent) significantly influenced LRC (P = 0.003) and only primary tumor site (oral cavity vs nonoral cavity) significantly influenced DSS (P = 0.04). Among the patients treated for recurrent disease, site of recurrence (undissected vs dissected tissue) significantly influenced both LRC and DSS (P= 0.008 and 0.001, respectively). Conclusions. Patients with recurrent SCC of the head and neck do poorly as compared with those with primary disease when treated with standard postoperative RT, particularly when the recurrence is within previously dissected tissue. This patient group should be targeted for alternative treatment strategies.