Intensity-modulated radiotherapy for recurrent and second primary head and neck cancer in previously irradiated territory

Duprez, Frédéric; Madani, Indira; Bonte, Katrien; Boterberg, Tom; Vakaet, Luc; Derie, C.; Gersem, Werner De; Neve, Wilfried De

doi:10.1016/j.radonc.2009.10.012

Cited by 95 publications

(66 citation statements)

References 36 publications

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“…Radiation therapy intensity modulated (IMRT) has increasingly been shown to be advantageous compared with traditional techniques. 56 Novel therapies that target specific molecular components have been evaluated, for example, EGFR (Epidermal growth factor receptor), is overexpressed in more than 90% in the HNSCC, may be treated with tyrosine kinase inhibitors.…”

Section: Treatmentmentioning

confidence: 99%

Human papillomavirus associated head and neck squamous cell carcinoma: Controversies and new concepts

Husain

Neyaz

2017

Journal of Oral Biology and Craniofacial Research

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High-risk human papillomavirus (HR-HPV) is a causative agent for an increasing subset of oropharyngeal squamous cell carcinoma. HPV 16 accounts for 90% of cases. The chance for malignant transformation due to infection with high-risk HPV is proportional to the expression of the viral oncogene products E6 and E7, which inactivate p53 and retinoblastoma (Rb) tumor suppressor functions. P16 is a surrogate marker of HPV associated HNSCC and 2+/3+ expression in more than 75% cells is diagnostic. Molecular demonstration of integrated virus by in situ hybridization is specific but has low sensitivity. HPV associated oropharyngeal carcinomas classically arise in the tonsillar crypts and commonly have basaloid morphology with a prominent lymphocytic repsonse and minimal despmoplastic reaction. In situ vs invasive carcinomas may be difficult to distinguish in histology. The HPV postitivity overrides traditional prognostic indicators such as tumour grade and histological subtype. Small cell morphology carries a poorer prognosis as does marked tumour anaplasia and multinucleation. Lymph node metastasis is extensive and frequently cystic however extranodal extension, laterality or nodal sizes do not carry prognostic implications as in conventional OSCC and OPSCC. Stage IV is reserved for distant metastasis. HPV-16-positive patients had significantly reduced overall and disease-specific mortality rates and an improved 3-year overall survival (OS) and disease-free survival (DFS) compared to patients with HPV negative tumors. Surgical treatment is the main option for primary and secondary HNSCC. Targeted therapies including drugs targeting EGFR and PIK3CA and have shown some promising results. HPV pathway expressing tumors are less aggressive and may receive adequate curative intent therapy from a reduced radiation or chemotherapy dose revision. OSCC however fails to show a distinct difference between HPV associated and tobaccco associated cancer and prognostic differences do not clearly exist.

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Section: Treatmentmentioning

confidence: 99%

Human papillomavirus associated head and neck squamous cell carcinoma: Controversies and new concepts

Husain

Neyaz

2017

Journal of Oral Biology and Craniofacial Research

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“…In conclusion, it can be stated that the results of external beam reirradiation therapy used to treat head and neck cancer relapse, according to the treatment techniques, are: using IMRT, 2-year overall survival was 35-58%, locoregional control was 42-64%, 2-year progressionfree survival reaches 42%, while the frequency of grade 3 and 4 toxicity was 13.1-20%, frequency of grade 5 radiotherapy reactions up to 2.8% [16,25,26,28]. Results from F-SBRT studies: 2-year overall survival was 14.3-40%, local control 40.4%, progression-free survival was 52.2%, frequency of late severe complications was 8.6-14%, frequency of grade 5 complications was 2.8-14% [16,22,23,28] (Table 1).…”

Section: Intensity-modulated Radiotherapy and Stereotactic Body Radiomentioning

confidence: 91%

“…Studies published by De Crevoisier et al and Duprez et al indicate osteoradionecrosis frequencies of 8% and 3.6%, when administering total cumulative dose of 130 Gy, using conventional radiotherapy [10,26]. In a research conducted by Salama et al, the total cumulative dose was 135 Gy, and frequency of osteoradionecrosis was 11% [41].…”

Section: Mandiblementioning

confidence: 98%

“…Severe late toxicity (grade 3 and 4) was observed in 15 (20%) patients; one patient died (grade 5 toxic reaction). Duprez et al published medical results based on 84 patients treated for recurrent or secondary head and neck cancer using IMRT [26]. Concurrent platinum-based chemotherapy was administered to 17 (20%) patients, 19 patients underwent surgical treatment and IMRT.…”

Section: Intensity-modulated Radiotherapy and Stereotactic Body Radiomentioning

confidence: 99%

“…When applying fractionation regimen of 2 Gy/day, and after irradiating the full cord cross-section to a total dose of 50, 60 and ∼69 Gy, the frequency of myelopathy was 0.2%, 6% and 50%, respectively [39]. However, most authors recommend not to exceed the cumulative dose of 50 Gy [19,24,26]. When using the hypofractionated stereotactic body radiation therapy, it is recommended not to exceed the cumulative dose of 25 Gy (2 Gyequivalent dose, α/β = 2), when the total dose of primary radiotherapy does not exceed 50 Gy and the minimal time between two radiotherapy courses is 5 months [40].…”

Section: Spinal Cord and Brain Stemmentioning

confidence: 99%

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Re-irradiation for Recurrent Head and Neck Cancer

Rudžianskas¹,

Kupčinskaitė-Noreikienė²

2017

Radiotherapy

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After radical treatment of head and neck cancer about 20-50% of patients are diagnosed with the locoregional recurrence during first two years. The main treatment for recurrent disease is salvage surgery, but in most cases, surgery is not feasible due to the high risk of complications and morbidity, and only 20% of patients are suitable for surgical salvage. Reirradiation is an effective treatment method with acceptable toxicity, but this treatment method is limited to normal tissue tolerance to a total dose. When chemotherapy is administered for recurrence, the response rate is up to 40%, so with the advancement of technical measures, after introduction of intensity-modulated radiotherapy, fractionated stereotactic body radiation therapy, high-dose-rate brachytherapy, proton beam reirradiation, a reirradiation is increasingly more often used for head and neck cancer relapse treatment. In this chapter, we will discuss about reirradiation with curative intent using new different radiation techniques (intensity-modulated radiotherapy (IMRT), stereotactic body radiation therapy (SBRT), high-dose-rate brachytherapy (HDR-BRT) and proton beam reirradiation (PBRT) for previously irradiated head and neck cancer and present recommendations for retreatment of head and neck cancer relapse using reirradiation alone or with systemic chemotherapy/biologic therapy.

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Survival prognostic factors for metachronous second primary head and neck squamous cell carcinoma

et al. 2016

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We examined the overall survival rates of a national cohort to determine optimal treatments and prognostic factors for patients with metachronous second primary head and neck squamous cell carcinomas (mspHNSCCs) at different stages and sites. We analyzed data of mspHNSCC patients collected from the Taiwan Cancer Registry database. The patients were categorized into four groups based on the treatment modality: Group 1 (control arm; chemotherapy [CT] alone), Group 2 (reirradiation [re‐RT] alone with intensity‐modulated radiotherapy [IMRT]), Group 3 (concurrent chemoradiotherapy alone [irradiation with IMRT]), and Group 4 (salvage surgery with or without RT or CT). We enrolled 1741 mspHNSCC patients without distant metastasis. Multivariate Cox regression analyses revealed that Charlson comorbidity index (CCI) ≥6, stage of second HNSCC, stage of first HNSCC, and duration from first primary HNSCC of <3 years were significant poor independent prognostic risk factors for overall survival. After adjustment, adjusted hazard ratios and 95% confidence intervals for the overall all‐cause mortality risk at mspHNSCC clinical stages III and IV were 0.72 (0.40–1.82), 0.52 (0.35–0.75), and 0.32 (0.22–0.45) in Groups 2, 3, and 4, respectively. A Cox regression analysis indicated that a re‐RT dose of ≥6000 cGy was an independent protective prognostic factor for treatment modalities. CCI ≥ 6, stage of second HNSCC, stage of first HNSCC, and duration from first primary HNSCC of <3 years were significant poor independent prognostic risk factors for overall survival. A re‐RT dose of ≥6000 cGy may be necessary for mspHNSCCs.

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Intensity-modulated radiotherapy for recurrent and second primary head and neck cancer in previously irradiated territory

Cited by 95 publications

References 36 publications

Human papillomavirus associated head and neck squamous cell carcinoma: Controversies and new concepts

Human papillomavirus associated head and neck squamous cell carcinoma: Controversies and new concepts

Re-irradiation for Recurrent Head and Neck Cancer

Survival prognostic factors for metachronous second primary head and neck squamous cell carcinoma

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