Boron neutron capture therapy outcomes for advanced or recurrent head and neck cancer

Abstract

We retrospectively review outcomes of applying boron neutron capture therapy (BNCT) to unresectable advanced or recurrent head and neck cancers. Patients who were treated with BNCT for either local recurrent or newly diagnosed unresectable head or neck cancers between December 2001 and September 2007 were included. Clinicopathological characteristics and clinical outcomes were retrieved from hospital records. Either a combination of borocaptate sodium and boronophenylalanine (BPA) or BPA alone were used as boron compounds. In all the treatment cases, the dose constraint was set to deliver a dose <10–12 Gy-eq to the skin or oral mucosa. There was a patient cohort of 62, with a median follow-up of 18.7 months (range, 0.7–40.8). A total of 87 BNCT procedures were performed. The overall response rate was 58% within 6 months after BNCT. The median survival time was 10.1 months from the time of BNCT. The 1- and 2-year overall survival (OS) rates were 43.1% and 24.2%, respectively. The major acute Grade 3 or 4 toxicities were hyperamylasemia (38.6%), fatigue (6.5%), mucositis/stomatitis (9.7%) and pain (9.7%), all of which were manageable. Three patients died of treatment-related toxicity. Three patients experienced carotid artery hemorrhage, two of whom had coexistent infection of the carotid artery. This study confirmed the feasibility of our dose-estimation method and that controlled trials are warranted.

Clinical potential of boron neutron capture therapy for locally recurrent inoperable previously irradiated head and neck cancer

“…The clinical potential of BNCT has been reported in several solid tumours, including Glioblastoma Multiforme (GBM), recurrent head and neck cancer, malignant melanoma and hepatocellular carcinoma (reviewed in (Barth and Joensuu, 2007)). A median survival of 9.7 months and 13.1 months for BNCTtreated patients with recurrent HNC was reported in two out of the 7 eligible trials (Kankaanranta et al, 2012;Suzuki et al, 2014). This is an improvement from an estimated lifespan of 6 months had these patients been offered supportive care only (Zafereo et al, 2009).…”

“…Seven phase I and phase II BNCT trials reporting the use of BNCT with intravenous administration of boron-carrier in patients with previously treated loco-regionally recurrent unresectable HNC were identified. Ariyoshi et al, 2007;Kankaanranta et al, 2012;Kato et al, 2009;Kimura et al, 2009;Suzuki et al, 2014;Wang et al, 2011). The EXTREME phase III randomized controlled trial evaluating clinical outcomes of standard systemic therapy in this same category of patients was included to assess standard therapy (Vermorken and Specenier, 2010).…”

“…The incidence of Grade 3 toxicities was up to 53%, while that of Grade 4 was below 10%. Three treatment-related deaths were reported in a single trial (Suzuki et al, 2014). Mucositis was the most commonly reported toxicity.…”

“…Median overall survival of 13.1 and 9.7 months were reported (Kankaanranta et al, 2012;Suzuki et al, 2014). A survival time of up to 72 months was reported for one patient after receiving seven BNCT treatments over 6 years (Kato et al, 2009).…”

“…A survival time of up to 72 months was reported for one patient after receiving seven BNCT treatments over 6 years (Kato et al, 2009). Reports of progression-free survival ranged from 5.1 to 7.9 months (Kankaanranta et al, 2012;Suzuki et al, 2014). Reported response rates, based on the Response Evaluation Criteria for solid tumours, ranged from 61% to 100%.…”