A retrospective study of head and neck re-irradiation for patients with recurrent or second primary head and neck cancer: The McGill University experience

Al‐Wassia, Rolina; Vakilian, Siavosh; Holly, Crystal; Sultanem, Khalil; Shenouda, George

doi:10.1186/s40463-015-0084-4

Cited by 14 publications

(13 citation statements)

References 25 publications

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“…23,29 The studies varied widely in terms of patient populations, radiation dose/fractionation, and the use of concurrent systemic therapy (CRT). We have summarized these studies in Table 1, [11][12][13][14]23,[29][30][31][32][33][34][35][36][37][38][39][40] and below present a more detailed summary of the larger, more relevant studies.…”

Section: Intensity-modulated Radiotherapy Reirradiationmentioning

confidence: 99%

Reirradiation of head and neck cancer using modern highly conformal techniques

Phan

2018

Head & Neck

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Locoregional disease recurrence or development of a second primary cancer after definitive radiotherapy for head and neck cancers remains a treatment challenge. Reirradiation utilizing traditional techniques has been limited by concern for serious toxicity. With the advent of newer, more precise radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT), proton radiotherapy, and stereotactic body radiotherapy (SBRT), there has been renewed interest in curative-intent head and neck reirradiation. However, as most studies were retrospective, single-institutional experiences, the optimal modality is not clear. We provide a comprehensive review of the outcomes of relevant studies using these 3 head and neck reirradiation techniques, followed by an analysis and comparison of the toxicity, tumor control, concurrent systemic therapy, and prognostic factors. Overall, there is evidence that IMRT, proton therapy, and SBRT reirradiation are feasible treatment options that offer a chance for durable local control and survival. Prospective studies, particularly randomized trials, are needed.

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Section: Intensity-modulated Radiotherapy Reirradiationmentioning

confidence: 99%

Reirradiation of head and neck cancer using modern highly conformal techniques

Phan

2018

Head & Neck

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“…Again, the outcomes were quite promising taking into account that the recurrent tumors were more advanced than in our previous study. loco-regional control rate inside the re-irradiated areas of 75% was at the top of the range of 44-80% found in other studies (15)(16)(17)(18)(19)(20). And the 1-year survival rate of 50% was well in the range of 33% to 77% reported in the other studies.…”

Section: Discussionmentioning

confidence: 53%

“…Moreover, the 1-year survival rate of 75% was more favorable than in most other recent studies using chemoradiation or external beam radiotherapy alone including modern high-precision techniques such as tomotherapy, CyberKnife ® , protons and charged particles for an advanced loco-regional recurrence of SCCHN. The 1-year survival rates in most of the other studies ranged from 33% to 62.5% (15)(16)(17)(18)(19). In one study using conformal radiotherapy, intensity-modulated radiotherapy or tomotherapy, the survival at 1 year was 77% (20).…”

Section: Discussionmentioning

confidence: 99%

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Re-irradiation with 36 Gy (1.5 Gy Twice Daily) Plus Paclitaxel for Advanced Recurrent and Previously Irradiated SCCHN is Feasible

Rades

Bartscht

Idel

et al. 2018

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Abstract. Background About half the patients who were treated for advanced nonmetastatic squamous cell carcinoma of the head and neck (SCCHN) develop a loco-regional recurrence either at the primary tumor site and/or in regional lymph nodes (1-3). In case of such a recurrence, a complete resection is often not safely possible, and the patients are referred to radiotherapy, ideally combined with concurrent chemotherapy (4). However, many of these patients had already received 60-70 Gy of radiotherapy (usually with 5 daily fractions of 2 Gy per week) as part of their primary treatment, either as a definitive or an adjuvant approach. For the treatment of a loco-regional recurrence, the second course of radiotherapy cannot be safely administered with 60-70 Gy again when taking into account the tolerance doses of the organs at risk in the head and neck region (5). This problem may be partly overcome with the addition of concurrent chemotherapy, which can be assumed to represent more than additional 10% of the radiotherapy dose regarding the effect of tumor cell kill (6). Cisplatin and carboplatin are the most commonly used agents for SCCHN. However, many patients, particularly in recurrent disease after chemoradiation, may not be able to receive platin-based chemotherapy again due to expected toxicity such as nausea, vomiting and renal failure (7). For these patients, taxanes may be an alternative option, since these agents have been proved effective as a monotherapy in patients with SCCHN (8-10). In addition to concurrent chemotherapy, twice-daily administration of radiotherapy with lower doses per fraction (e.g. of 1.5 Gy) is a relatively novel approach to improve treatment outcome in such coditions. The risk of late radiation morbidity can be decreased with the use of lower doses per fraction (11). Normal tissues can recover from radiotherapy after 6 to 8 hours, whereas tumor cells generally do not recover. We followed this approach in a previous report of patients receiving mainly 30 Gy of radiotherapy with two daily fractions of 1.5 Gy supplemented by 20-25 mg/m 2 of paclitaxel administered twice weekly (12). However, the question arose whether a better outcome could be achieved with a higher radiation dose than 30 Gy. Therefore, we increased the total radiation dose to 36 Gy in the present series and investigated the feasibility and efficacy of this regimen. Patients and MethodsFour patients with head-and-neck cancer, two women and two men, underwent this therapy regimen. These patients had developed an advanced loco-regional recurrence of SCCHN following surgery plus postoperative platin-based chemoradiation. Two patients had oropharynx cancer, one patient cancer of the oral cavity and one 519

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“…The actuarial 2-year survival was 48% and a median OS of 1.9 years. 29 These good results in the aforementioned trials can be attributed to the use of intensity-modulated RT, which allowed the delivery of ReRT in a more conformal fashion, minimizing acute toxicities and reducing treatment interruptions, which allow delivery of radical doses to the tumor. Moreover, the majority of patients enrolled in these trials have received concomitant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of reirradiation for patients with locoregional recurrent head and neck cancer: A single-institution experience

Salem

2016

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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Aim: To assess the efficacy of reirradiation in locoregionally recurrent head and neck cancer (HNC) and to describe results in our center in relation to other published data among similar group of patients. Methods: The medical records of 28 patients with HNC who received reirradiation with or without chemotherapy for loco-regional recurrence between 2005 and 2013 were reviewed. They were evaluated for; toxicity profile, overall survival (OS) and progression free survival (PFS). Results: The median reirradiation dose was 50 Gy (range 40-60 Gy) and median radiation cumulative dose was 119 (range 113-120). An overall response rate was seen in 36% of patients with only 3 patients showed complete response. The median OS was 9 months with 1-and 2-year survival rates being 34.1% and 10.6%. The OS and PFS were significantly better in patients who were treated with chemotherapy concomitant with radiation and received higher radiation dose. Grade 3 mucositis and skin reactions were seen in 24 % and 14% of patients, respectively. Conclusion: Reirradiation appears to be feasible in patients with recurrent HNC treated previously with radiation. The benefit of concurrent chemotherapy with reirradiation is expected. Our results are subject to limitations from the retrospective nature of the analysis, the relatively small number, and improper selection of patients.

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A retrospective study of head and neck re-irradiation for patients with recurrent or second primary head and neck cancer: The McGill University experience

Cited by 14 publications

References 25 publications

Reirradiation of head and neck cancer using modern highly conformal techniques

Reirradiation of head and neck cancer using modern highly conformal techniques

Re-irradiation with 36 Gy (1.5 Gy Twice Daily) Plus Paclitaxel for Advanced Recurrent and Previously Irradiated SCCHN is Feasible

A retrospective study of reirradiation for patients with locoregional recurrent head and neck cancer: A single-institution experience

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