Reirradiation of Head and Neck Cancers With Intensity Modulated Radiation Therapy: Outcomes and Analyses

Journal Article · Fri Jul 15 04:00:00 EDT 2016 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2016.03.015· OSTI ID:22648727

Takiar, Vinita ^[1]; Garden, Adam S.; Ma, Dominic; Morrison, William H.; Edson, Mark ^[2]; Zafereo, Mark E. ^[3]; Gunn, Gary B.; Fuller, Clifton D.; Beadle, Beth; Frank, Steven J. ^[2]; William, William N.; Kies, Merrill ^[4]; El-Naggar, Adel K. ^[5]; Weber, Randal ^[3]; Rosenthal, David I. ^[2]; Phan, Jack ^[2]

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1. Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio (United States)
2. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
3. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
4. Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
5. Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

Purpose: To review our 15-year institutional experience using intensity modulated radiation therapy (IMRT) to reirradiate patients with head and neck squamous cell carcinomas (HNSCC) and identify predictors of outcomes and toxicity. Methods and Materials: We retrospectively reviewed the records of 227 patients who received head and neck reirradiation using IMRT from 1999 to 2014. Patients treated with noncurative intent were excluded. Radiation-related acute and late toxicities were recorded. Prognostic variables included performance status, disease site, disease-free interval, chemotherapy, and RT dose and volume. Correlative analyses were performed separately for surgery and nonsurgery patients. Results: Two hundred six patients (91%) were retreated with curative intent, and 173 had HNSCC histology; 104 (50%) underwent salvage resection, and 135 (66%) received chemotherapy. Median follow-up after reirradiation was 24.7 months. Clinical outcomes were worse for HNSCC patients, with 5-year locoregional control, progression-free survival, and overall survival rates of 53%, 22%, and 32%, respectively, compared with 74%, 59%, and 79%, respectively, for non-HNSCC patients. On multivariate analysis, concurrent chemotherapy and retreatment site were associated with tumor control, whereas performance status was associated with survival. Favorable prognostic factors specific to surgery patients were neck retreatment and lack of extracapsular extension, whereas for nonsurgery patients, these were a nasopharynx subsite and complete response to induction chemotherapy. Actuarial rates of grade ≥3 toxicity were 32% at 2 years and 48% at 5 years, with dysphagia or odynophagia being most common. Increased grade ≥3 toxicity was associated with retreatment volume >50 cm{sup 3} and concurrent chemotherapy. Conclusions: Reirradiation with IMRT either definitively or after salvage surgery can produce promising local control and survival in selected patients with head and neck cancers. Treatment-related toxicity remains significant. Prognostic factors are emerging to guide multidisciplinary treatment approaches and clinical trial design.

• OSTI ID: 22648727
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 95; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CHEMOTHERAPY
CLINICAL TRIALS
HEAD
MULTIVARIATE ANALYSIS
NECK
NEOPLASMS
PATIENTS
PERFORMANCE
RADIOTHERAPY
SURGERY
TOXICITY