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Some patients received 2 years of treatment and the responses were ongoing for more than 30 months; the durable anti-tumour activity and tolerable safety profile, observed with long-term follow-up, support the use of pembrolizumab as a treatment for recurrent/metastatic HNSCC.

Purpose Re-irradiation (re-RT) of recurrent head and neck cancer (HNC) may achieve long term disease control in some patients, at the expense of high rates of late sequelae. Limiting the re-RT targets to the recurrent gross tumor volume (rGTV) would reduce the volumes of re-irradiated tissues, however, its effect on tumor recurrence pattern is unknown. Methods Retrospective review of 66 patients who underwent curative-intent re-RT for non-resectable recurrent or second primary mucosal squamous cell HNC. Treatment was delivered with 3-dimensional conformal (3D) RT or intensity modulated RT (IMRT). The targets in all patients consisted of the rGTVs with tight (0.5 cm) margins, with no intent to treat prophylactically lymph nodes or sub-clinical disease in the vicinity of the rGTVs. The sites of local-regional failures (LRFs) were determined using imaging at the time of failure, and were compared to the rGTVs. Results Median re-RT dose was 68 Gy. 47 patients (71%) received concomitant chemotherapy and 31 (47%) received hyperfractionated, accelerated RT. At a median follow up 42 month, 16 (23%) are alive and free of disease. Fifty patients (77%) had a third recurrence or persistent disease, including 47 LRFs. All LRFs occurred within the rGTVs except for two (4%) (95% C.I. 0; 11 %). Nineteen patients (29%) had grade ≥3 late complications, mostly dysphagia (12 patients). Conclusion Almost all LRFs occurred within the re-irradiated rGTVs despite avoiding prophylactic RT of tissue at risk of subclinical disease. These results support confining the re-RT targets to the rGTVs to reduce re-irradiated tissue volumes.

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