Presented in part at the 6th National EBM day on Nasal and Paranasal Sinus Malignancies at the National Otolaryngology Trials Office, Newcastle upon Tyne, UK
Re-irradiation with concurrent chemotherapy in recurrent head and neck cancer: a decision analysis model based on a systematic review
Article first published online: 18 AUG 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Volume 33, Issue 4, pages 331–337, August 2008
How to Cite
Paleri, V. and Kelly, C.G. (2008), Re-irradiation with concurrent chemotherapy in recurrent head and neck cancer: a decision analysis model based on a systematic review. Clinical Otolaryngology, 33: 331–337. doi: 10.1111/j.1749-4486.2008.01738.x
- Issue published online: 18 AUG 2008
- Article first published online: 18 AUG 2008
- Accepted for publication 17 April 2008
Objectives: Local recurrence is the major cause of treatment failure in head and neck cancer patients after radiation or combined therapy. If surgically unresectable, management involves supportive care or chemotherapy with palliative intent. Recent studies have assessed the role of re-irradiating these patients with concurrent chemotherapy (CTReRT) and have reported improved local control. The aim of this study was to perform a decision analysis model comparing quality adjusted life years (QALYs) between patients undergoing CTReRT and best supportive care for radio-recurrent head and neck squamous cancer.
Design: Outcome data from recent reviews on the topic were used. A decision analysis model was generated. An expert panel arrived at a consensus to assign utility values for the various health state outcomes when CTReRT is administered for recurrent cancer, or in the setting of palliative care for these patients.
Main outcome measures: Quality adjusted life years from the decision analysis model.
Results: Patients who do not suffer a severe complication following CTReRT were assigned by the expert panel to have a utility value of 0.7, and those who suffered one, a utility value of 0.6. A value of 1.0 equates to perfect health and 0 to death. The utility value assigned in the setting of good palliation was 0.8, with 0.6 given when symptom control was less than optimal. The model showed superior QALYs for the CTReRT arm of approximately 5 weeks (20 weeks versus 15 weeks for palliation).
Conclusions: Re-irradiation with concurrent chemotherapy is a modality to be considered in select patients with recurrent head and neck cancer. These results should help to better inform both patients and clinicians when considering this treatment.