Identification of Factors Affecting Recurrence in Patients with Locally Advanced Head and Neck Cancer Treated by IMRT and VMAT

Background: Recurrent disease in head and neck SCC is a major cause of 
morbidity and an obstacle to long-term survival in squamous cell carcinoma of 
the head and neck. Locoregional recurrence is a major factor contributing to 
deaths from head and neck cancer. Recurrent head and neck cancer is 
challenging to treat for multiple reasons, including the effects of prior treatment 
on tumor cells, as well as the fact that the recurrent disease is usually infiltrative 
and multifocal. 
Patients and methods: The medical records of patients with locally advanced 
squamous cell carcinoma of the head and neck who underwent radical treatment 
with IMRT or VMAT were retrospectively reviewed for our study. The data 
were collected from the files regarding patient characteristics such as age, sex, 
and special habits with a focus on smoking, alcohol consumption, and 
comorbidity, as well as disease characteristics as tumor site and size, grade, 
nodal status, extracapsular extension, and margin status. All these factors were 
correlated with the pattern of failure either locoregional or distant metastasis.
Results: The highest percentage is laryngeal SCC (74.8%) followed by 
pharyngeal and oral cavity SCC (10%) and finally others as lip, external 
auditory canal, and paranasal sinuses (5%). Out of 110 patients with head and 
neck SCC treated with radiation treatment, either adjuvant by intensity-
modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT), 
or radical therapy, 17 patients (15.4%) experienced a recurrence of the disease. 
A statistically significant correlation between recurrence and LVI, PNI and 
ECE. There was no significant correlation between recurrences in head and neck 
and chemotherapy received, surgery done, or neck dissection.
Conclusion: Recurrences in head and neck squamous cell carcinoma are an 
obstacle to long-term survival in squamous cell carcinoma of the head and neck. 
There was a great association between recurrence and biological parameters, 
such as positive surgical margin, LVI, and PNI as well as treatment regularity. 
There was no statistical significance between treatment failure and age, sex, 
smoking, family history, comorbidities, primary tumor site, size of clinically 
detected lymph nodes, and induction or concurrent chemotherapy received. It is 
important to avoid factors that can lead to radiotherapy failure to reduce the risk 
of local recurrence. This can be achieved by utilizing advanced radiotherapy 
techniques and carefully selecting the primary treatment method.