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

Takiar, Vinita; Garden, Adam S.; Ma, Dominic; Morrison, William H.; Edson, Mark A.; Zafereo, Mark; Gunn, G. Brandon; Fuller, Clifton D.; Beadle, Beth M.; Frank, Steven J.; William, William N.; Kies, Merrill S.; El‐Naggar, Adel K.; Weber, Randal S.; Rosenthal, David I.; Phan, Jack

doi:10.1016/j.ijrobp.2016.03.015

Cited by 113 publications

(165 citation statements)

References 25 publications

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“…The importance of long‐term follow‐up for proper estimations of late complication and survival rates has been clearly documented 16, 17. Previously reported 2‐year locoregional control rates after reirradiation range from 10% to 64%, but long‐term follow‐up data are scarce 11, 12, 18, 19, 20, 21. OS rates in these reports vary from 10% to 58% depending on patient selection criteria.…”

Section: Discussionmentioning

confidence: 99%

“…This includes extensive fibrosis, soft tissue necrosis, osteoradionecrosis (ORN), myelopathy, and carotid artery blowout. In literature, serious (European Organization for Research and Treatment of Cancer [EORTC]/Radiation Therapy Oncology Group [RTOG] grade 3 or higher) late treatment complication rates of up to 50% are reported, although rates vary greatly because of heterogeneous study populations 8, 9, 10, 11, 12…”

Section: Introductionmentioning

confidence: 99%

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Reirradiation of head and neck cancer: Long‐term disease control and toxicity

et al. 2017

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BackgroundThe purpose of this study was to report long‐term disease control and late radiation toxicity for patients reirradiated for head and neck cancer.MethodsWe conducted a retrospective analysis of 137 patients reirradiated with a prescribed dose ≥45 Gy between 1986 and 2013 for a recurrent or second primary malignancy. Endpoints were locoregional control, overall survival (OS), and grade ≥4 late complications according to European Organization for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) criteria.ResultsFive‐year locoregional control rates were 46% for patients reirradiated postoperatively versus 20% for patients who underwent reirradiation as the primary treatment (p < .05). Sixteen cases of serious (grade ≥4) late toxicity were seen in 11 patients (actuarial 28% at 5 years). In patients reirradiated with intensity‐modulated radiotherapy (IMRT), a borderline improved locoregional control was observed (49% vs 36%; p = .07), whereas late complication rates did not differ.ConclusionReirradiation should be considered for patients with a recurrent or second primary head and neck cancer, especially postoperatively, if indicated. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1122–1130, 2017

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reirradiation of head and neck cancer: Long‐term disease control and toxicity

et al. 2017

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“…Recent review on 15 years (1999–2014) of large sized data from MD Anderson Cancer Center using IMRT has clarified the predictors of outcomes and toxicity in re-irradiated patients with HNSCC [30]. Total 206 patients including 173 with HNSCC histology were retreated with curative aim.…”

Section: Latest Clinical Data From Reirradiation Using Imrtmentioning

confidence: 99%

“…One hundred four patients (50%) underwent salvage surgery while 102 patients treated with non-surgical treatment. With a median 24.7 months of follow-up after reirradiation, clinical outcomes were worse for HNSCC patients in 5-year LRC, PFS, and OS rates (53%, 22%, and 32%, respectively), than for non-HNSCC patients (74%, 59%, and 79%, respectively) [30]. Favorable prognostic factors in multivariate analysis after salvage surgery were neck retreatment and lack of ECE.…”

Section: Latest Clinical Data From Reirradiation Using Imrtmentioning

confidence: 99%

Reirradiation of head and neck cancer in the era of intensity-modulated radiotherapy: patient selection, practical aspects, and current evidence

Kim

2017

Radiat Oncol J

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Locoregional failure is the most frequent pattern of failure in locally advanced head and neck cancer patients and it leads to death in most of the patients. Second primary tumors occurring in the other head and neck region reach up to almost 40% of long-term survivors. Recommended and preferred retreatment option in operable patients is salvage surgical resection, reporting a 5-year overall survival of up to 40%. However, because of tumor location, extent, and underlying comorbidities, salvage surgery is often limited and compromised by incomplete resection. Reirradiation with or without combined chemotherapy is an appropriate option for unresectable recurrence. Reirradiation is carefully considered with a case-by-case basis. Reirradiation protocol enrollment is highly encouraged prior to committing patient to an aggressive therapy. Radiation doses greater than 60 Gy are usually recommended for successful salvage. Despite recent technical improvement in intensity-modulated radiotherapy (IMRT), the use of concurrent chemotherapy, and the emergence of molecularly targeted agents, careful patient selection remain as the most paramount factor in reirradiation. Tumors that recur or persist despite aggressive prior chemoradiation therapy imply the presence of chemoradio-resistant clonogens. Treatment protocols that combine novel targeted radiosensitizing agents with conformal high precision radiation are required to overcome the resistance while minimizing toxicity. Recent large number of data showed that IMRT may provide better locoregional control with acceptable acute or chronic morbidities. However, additional prospective studies are required before a definitive conclusion can be drawn on safety and effectiveness of IMRT.

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“…Takiar et al completed a 15-year analysis and published its results, which include: chondroradionecrosis after delivering 140 Gy total cumulative dose; non-healing ulcer and stenosis requiring surgery after ≥120 Gy [42]. It is therefore recommended that the total cumulative dose for larynx and hypopharynx does not exceed 120 Gy.…”

Section: Larynx/hypopharynxmentioning

confidence: 99%

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

Cited by 113 publications

References 25 publications

Reirradiation of head and neck cancer: Long‐term disease control and toxicity

Reirradiation of head and neck cancer: Long‐term disease control and toxicity

Reirradiation of head and neck cancer in the era of intensity-modulated radiotherapy: patient selection, practical aspects, and current evidence

Re-irradiation for Recurrent Head and Neck Cancer

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