Re-irradiation of Head-and-Neck Cancer With Highly Conformal Tomotherapy IMRT

Re-irradiation of Head-and-Neck Cancer With Highly Conformal Tomotherapy IMRT Purpose/Objective(s)</h5> There is no standard of care regarding re-irradiation of the head and neck. The difficulty of balancing the benefit of tumor control with that of increased normal tissue toxicity may be partially negated with proper patient selection and highly conformal radiation therapy. The purpose of this study was to analyze the outcomes of patients with a second primary and/or recurrent head and neck cancer treated with re-irradiation.</P>Materials/Methods</h5> We retrospectively reviewed 24 patients treated with re-irradiation to the head and neck, between March 2008 and August 2013. There were 17 patients with recurrent tumors, 5 with second primaries, and 2 with both second primaries and recurrences. Tumor factors included volume of recurrence (median 12.5 cm 3 , range 1.5-400), and recurrence location (local only (12), neck only (5), local + neck (3), and local + distant (3). Patient factors included age, median 62 (27-77), and performance status, (20 with ECOG 0-1, 4 with EOCG 2-3). 3 patients were unresectable and underwent biopsy only; 4 underwent subtotal resection or debulking; 17 patients underwent gross total resection; 13 with positive margins; 4 with negative margins. All but 2 patients were treated with conventionally fractionated tomotherapy IMRT. 14 patients underwent concurrent chemoradiation, typically with platinum based regiments.</P>Results</h5> Patients were followed for a median of 23.5 months, minimum of 13 months among survivors. Patients were treated with a median dose of 60 Gy (44-70). Kaplan-Meier estimates for 1 year local control, recurrence free survival, and overall survival were 49% (95% CI 28-67), 33% (95% CI 16-52), and 63% (95% CI 40-78). 2 year local control, recurrence free survival, and overall survival were 35% (95% CI 14-56), 17% (95% CI 5-36), and 22% (95% CI 7-42). Median survival was 15 months (95% CI 10-19). There were 5 long term survivors with a range of 14-40 months without evidence of disease. Death was more likely due to cancer recurrence, however two patients died secondary to carotid artery bleeds after re-irradiation. 16 (66.7%) patients experienced moderate to high grade toxicity, with half of the patients (n=12) PEG dependent after treatment.</P>Conclusion</h5> In our series, patients were treated with highly conformal conventionally fractionated Tomotherapy IMRT. Outcomes are similar to those achieved in other published series. Local control at 1 and 2 years was 49% and 35%, respectively. Treatment options for these patients are limited. The heterogeneity and the small sample size limit generalizability of the study results to future patient management. Given the morbidity due to local progression of recurrent tumor, it is reasonable to consider re-irradiation in select patients.</P> http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Radiation Oncology Biology Physics Elsevier

Re-irradiation of Head-and-Neck Cancer With Highly Conformal Tomotherapy IMRT

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Publisher
Elsevier
Copyright
Copyright © 2014 Elsevier Ltd
ISSN
0360-3016
DOI
10.1016/j.ijrobp.2013.11.145
Publisher site
See Article on Publisher Site

Abstract

Purpose/Objective(s)</h5> There is no standard of care regarding re-irradiation of the head and neck. The difficulty of balancing the benefit of tumor control with that of increased normal tissue toxicity may be partially negated with proper patient selection and highly conformal radiation therapy. The purpose of this study was to analyze the outcomes of patients with a second primary and/or recurrent head and neck cancer treated with re-irradiation.</P>Materials/Methods</h5> We retrospectively reviewed 24 patients treated with re-irradiation to the head and neck, between March 2008 and August 2013. There were 17 patients with recurrent tumors, 5 with second primaries, and 2 with both second primaries and recurrences. Tumor factors included volume of recurrence (median 12.5 cm 3 , range 1.5-400), and recurrence location (local only (12), neck only (5), local + neck (3), and local + distant (3). Patient factors included age, median 62 (27-77), and performance status, (20 with ECOG 0-1, 4 with EOCG 2-3). 3 patients were unresectable and underwent biopsy only; 4 underwent subtotal resection or debulking; 17 patients underwent gross total resection; 13 with positive margins; 4 with negative margins. All but 2 patients were treated with conventionally fractionated tomotherapy IMRT. 14 patients underwent concurrent chemoradiation, typically with platinum based regiments.</P>Results</h5> Patients were followed for a median of 23.5 months, minimum of 13 months among survivors. Patients were treated with a median dose of 60 Gy (44-70). Kaplan-Meier estimates for 1 year local control, recurrence free survival, and overall survival were 49% (95% CI 28-67), 33% (95% CI 16-52), and 63% (95% CI 40-78). 2 year local control, recurrence free survival, and overall survival were 35% (95% CI 14-56), 17% (95% CI 5-36), and 22% (95% CI 7-42). Median survival was 15 months (95% CI 10-19). There were 5 long term survivors with a range of 14-40 months without evidence of disease. Death was more likely due to cancer recurrence, however two patients died secondary to carotid artery bleeds after re-irradiation. 16 (66.7%) patients experienced moderate to high grade toxicity, with half of the patients (n=12) PEG dependent after treatment.</P>Conclusion</h5> In our series, patients were treated with highly conformal conventionally fractionated Tomotherapy IMRT. Outcomes are similar to those achieved in other published series. Local control at 1 and 2 years was 49% and 35%, respectively. Treatment options for these patients are limited. The heterogeneity and the small sample size limit generalizability of the study results to future patient management. Given the morbidity due to local progression of recurrent tumor, it is reasonable to consider re-irradiation in select patients.</P>

Journal

International Journal of Radiation Oncology Biology PhysicsElsevier

Published: Feb 1, 2014

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