Salvage Re-Irradiation for Recurrent Head and Neck Cancer

Journal Article · Sun Jul 01 04:00:00 EDT 2007 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2006.12.055· OSTI ID:20951699

Lee, Nancy ^[1]; Chan, Kelvin ^[1]; Bekelman, Justin E ^[1]; Zhung, Joanne ^[1]; Mechalakos, James ^[2]; Narayana, Ashwatha ^[1]; Wolden, Suzanne ^[1]; Venkatraman, Ennapadam S ^[3]; Pfister, David ^[4]; Kraus, Dennis ^[5]; Shah, Jatin ^[5]; Zelefsky, Michael J ^[1]

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1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
2. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
3. Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
4. Divisions of Head and Neck Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
5. Head and Neck Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

Purpose: To present a retrospective review of treatment outcomes for recurrent head and neck (HN) cancer patients treated with re-irradiation (re-RT) at a single medical center. Methods and Materials: From July 1996-September 2005, 105 patients with recurrent HN cancer underwent re-RT at our institution. Sites included were: the neck (n = 21), nasopharynx (n 21), paranasal sinus (n = 18), oropharynx (n = 16), oral cavity (n = 9), larynx (n = 10), parotid (n = 6), and hypopharynx (n = 4). The median prior RT dose was 62 Gy. Seventy-five patients received chemotherapy with their re-RT (platinum-based in the majority of cases). The median re-RT dose was 59.4 Gy. In 74 (70%), re-RT utilized intensity-modulated radiation therapy (IMRT). Results: With a median follow-up of 35 months, 18 patients were alive with no evidence of disease. The 2-year loco-regional progression-free survival (LRPFS) and overall survival rates were 42% and 37%, respectively. Patients who underwent IMRT, compared to those who did not, had a better 2-year LRPF (52% vs. 20%, p < 0.001). On multivariate analysis, non-nasopharynx and non-IMRT were associated with an increased risk of loco-regional (LR) failure. Patients with LR progression-free disease had better 2-year overall survival vs. those with LR failure (56% vs. 21%, p < 0.001). Acute and late Grade 3-4 toxicities were reported in 23% and 15% of patients. Severe Grade 3-4 late complications were observed in 12 patients, with a median time to development of 6 months after re-RT. Conclusions: Based on our data, achieving LR control is crucial for improved overall survival in this patient population. The use of IMRT predicted better LR tumor control. Future aggressive efforts in maximizing tumor control in the recurrent setting, including dose escalation with IMRT and improved chemotherapy, are warranted.

• OSTI ID: 20951699
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 68; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CHEMOTHERAPY
FAILURES
HEAD
IRRADIATION
LARYNX
MEDICAL ESTABLISHMENTS
MULTIVARIATE ANALYSIS
NECK
NEOPLASMS
ORAL CAVITY
PATIENTS
PHARYNX
PLATINUM
RADIATION DOSES
RADIOTHERAPY
REVIEWS
SINUSES
TOXICITY