Patterns of failure after salvage re-irradiation for recurrent head and neck cancer: implications for field design and consolidation therapy
Tóm tắt
The complications as a result of re-irradiation (re-RT) for recurrent head and neck cancer (HNC) can be devastating to the already very ill patient. We sought to examine the pattern of failure with the goal of designing optimal re-RT fields for these patients. From July 1996 to April 2011, 47 HNC patients treated with fractionated re-RT developed locoregional failure. Recurrence sites were oropharynx (n = 12), neck (n = 11), oral cavity (n = 9), larynx (n = 5), paranasal sinuses (n = 5), parotid (n = 4), and hypopharynx (n = 1). Median initial radiation therapy (RT) dose was 65 Gy and median time between radiations was 32.2 months. Salvage surgery was performed in 21 patients (45 %), and 37 patients (79 %) received concurrent chemotherapy. Median re-RT dose was 60 Gy, and all patients received intensity-modulated RT. Patterns of failure were assessed by reviewing target volume delineation and compared slice-by-slice visually alongside axial imaging documenting locoregional recurrence. There was no intention to encompass prophylactic subclinical regions at risk. Coding of failures was either in-field (InF) or out-of-field (OutF). All others were marginal failures (margF). With a median follow-up of 24.5 months, the median time to locoregional progression-free survival (LRPFS) was 5.3 months and median overall survival (OS) was 12.5 months. Failures were documented as InF in 42 patients (89 %), OutF in three patients (6 %), and margF in two patients (4 %). Five patients died while undergoing re-RT. Patients who developed OutF occurred at sites beyond 2 cm from the tumor volume. In our series of recurrent HNC patients who underwent salvage re-RT, the vast majority of locoregional failures were InF. We feel that confining re-RT targets to the gross tumor volume or postoperative clinical target volume without treating the subclinical regions at risk for failure is sufficient. With current image guidance capabilities, reducing the planning target volume margin may further minimize toxicities.
Tài liệu tham khảo
Abgral R et al (2009) Does 18f-fdg pet/ct improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up? J Nucl Med: Off Publ Soc Nucl Med 50:24–29
Biagioli MC et al (2007) Intensity-modulated radiotherapy with concurrent chemotherapy for previously irradiated, recurrent head and neck cancer. Int J Radiat Oncol Biol Phys 69:1067–1073
Cheng SC et al (2011) Assessment of post-radiotherapy salivary glands. Br J Radiol 84:393–402
Choe KS et al (2011) Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation. Cancer 117:4671–4678
Creak AL, Harrington K, Nutting C (2005) Treatment of recurrent head and neck cancer: re-irradiation or chemotherapy? Clin Oncol 17:138–147
De Crevoisier R et al (1998) Full-dose reirradiation for unresectable head and neck carcinoma: experience at the Gustave-Roussy Institute in a series of 169 patients. J Clin Oncol: Off J Am Soc Clin Oncol 16:3556–3562
De Crevoisier R et al (2001) Full dose reirradiation combined with chemotherapy after salvage surgery in head and neck carcinoma. Cancer 91:2071–2076
Furusaka T et al (2012) Long-term observations and salvage operations on patients with t2n0m0 squamous cell carcinoma of the glottic larynx treated with radiation therapy alone. Acta Otolaryngol 132:546–551
Goldstein DP et al (2008) Outcomes following reirradiation of patients with head and neck cancer. Head Neck 30:765–770
Hehr T et al (2005) Reirradiation alternating with docetaxel and cisplatin in inoperable recurrence of head-and-neck cancer: a prospective phase i/ii trial. Int J Radiat Oncol Biol Phys 61:1423–1431
Isles MG, McConkey C, Mehanna HM (2008) A systematic review and meta-analysis of the role of positron emission tomography in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy. Clin Otolaryngol: Off J ENT-UK; Off J Neth Soc Otorhinolaryngol Cervicofac Surg 33:210–222
Janot F et al (2008) Randomized trial of postoperative reirradiation combined with chemotherapy after salvage surgery compared with salvage surgery alone in head and neck carcinoma. J Clin Oncol: Off J Am Soc Clin Oncol 26:5518–5523
Karam SD et al (2012) Reirradiation of recurrent salivary gland malignancies with fractionated stereotactic body radiation therapy. J Radiat Oncol 1:147–153
Kramer NM et al (2005) Toxicity and outcome analysis of patients with recurrent head and neck cancer treated with hyperfractionated split-course reirradiation and concurrent cisplatin and paclitaxel chemotherapy from two prospective phase i and ii studies. Head Neck 27:406–414
Langer CJ et al (2007) Phase ii study of low-dose paclitaxel and cisplatin in combination with split-course concomitant twice-daily reirradiation in recurrent squamous cell carcinoma of the head and neck: results of radiation therapy oncology group protocol 9911. J Clin Oncol: Off J Am Soc Clin Oncol 25:4800–4805
Lee N et al (2007) Salvage re-irradiation for recurrent head and neck cancer. Int J Radiat Oncol Biol Phys 68:731–740
Machtay M et al (2004) Pilot study of postoperative reirradiation, chemotherapy, and amifostine after surgical salvage for recurrent head-and-neck cancer. Int J Radiat Oncol Biol Phys 59:72–77
McDonald MW, Moore MG, Johnstone PA (2012) Risk of carotid blowout after reirradiation of the head and neck: a systematic review. Int J Radiat Oncol Biol Phys 82:1083–1089
Popovtzer A et al (2009) The pattern of failure after reirradiation of recurrent squamous cell head and neck cancer: implications for defining the targets. Int J Radiat Oncol Biol Phys 74:1342–1347
Qiu S et al (2012) Intensity-modulated radiation therapy in the salvage of locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 83:676–683
Salama JK et al (2006) Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 64:382–391
Sher DJ et al (2010) Efficacy and toxicity of reirradiation using intensity-modulated radiotherapy for recurrent or second primary head and neck cancer. Cancer 116:4761–4768
Spencer SA et al (2001) Rtog 96-10: reirradiation with concurrent hydroxyurea and 5-fluorouracil in patients with squamous cell cancer of the head and neck. Int J Radiat Oncol Biol Phys 51:1299–1304
Spencer SA et al (2008) Final report of rtog 9610, a multi-institutional trial of reirradiation and chemotherapy for unresectable recurrent squamous cell carcinoma of the head and neck. Head Neck 30:281–288
Sulman EP et al (2009) Imrt reirradiation of head and neck cancer-disease control and morbidity outcomes. Int J Radiat Oncol Biol Phys 73:399–409
Tan HK et al (2010) Salvage surgery after concomitant chemoradiation in head and neck squamous cell carcinomas—stratification for postsalvage survival. Head Neck 32:139–147
Tanvetyanon T et al (2009) Prognostic factors for survival after salvage reirradiation of head and neck cancer. J Clin Oncol: Off J Am Soc Clin Oncol 27:1983–1991
Tortochaux J et al (2011) Randomized phase III trial (GORTEC 98-03) comparing re-irradiation plus chemotherapy versus methotrexate in patients with recurrent or a second primary head and neck squamous cell carcinoma, treated with a palliative intent. Radiother Oncol: J Eur Soc Ther Radiol Oncol 100:70–75
Wong LY et al (2003) Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgery. Head Neck 25:953–959
Zafereo ME et al (2009) The role of salvage surgery in patients with recurrent squamous cell carcinoma of the oropharynx. Cancer 115:5723–5733