Re-Irradiation of Recurrent Head and Neck Cancers Using Pulsed Reduced Dose Rate Radiotherapy: An Institutional Series

Abstract

Purpose/Objective(s): Pulsed reduced dose rate (PRDR) radiation (RT) is a re-irradiation (Re-RT) technique that potentially overcomes dose/volume constraints in the setting of previous radiation therapy. While the use of this Re-RT technique has been reported for other disease sites, there is minimal data for its use for recurrent or secondary primary squamous cell carcinoma of the head and neck (HNSCC). In this study, we report preliminary data from our institution of a consecutive cohort of patients with HNSCC who received PRDR Re-RT. Materials/Methods: Out of 11 patients who received PRDR Re-RT from August 2020 to January 2023, 9 had analyzable data. Intensity modulated RT was used for treatment delivery using either volume modulated arc therapy or helical tomotherapy. A wait time between 20cGy arc/helical deliveries was used to achieve the effective low dose rate. Data collected included patient demographic information, prior interventions, diagnosis, radiation therapy dose and fractionation, progression free survival, overall survival, and toxicity rates. Results: The median time to PRDR from completion of initial RT was 13 months (range, 6-50 months). All but one patient underwent salvage surgery prior to PRDR. In total, 4 patients received systemic therapy as part of their re-treatment courses. The median follow-up after Re-RT was 7 months. The median OS from PRDR was 7 months (range, 1-32 months). Median PFS was 7 months (range, 1-32 months). One patient (11.1%) had acute grade 3 toxicity, and two patients (22.2%) had late grade 3 toxicities. There were no acute or late grade 4 or 5 toxicities. Conclusion: PRDR for Re-RT is a feasible treatment strategy for patients with recurrent or second primary HNSCC. Initial findings from this retrospective review suggest reasonable survival outcomes and potentially improved toxicity; prospective data is needed to establish the safety and efficacy of this technique.