Re-irradiation for recurrent or second primary head and neck cancer

• Published in: Radiation oncology journal Vol. 39; no. 4; pp. 279 - 287
• Main Authors: Lee, Hye In, Kim, Jin Ho, Ahn, Soon-Hyun, Chung, Eun-Jae, Keam, Bhumsuk, Eom, Keun-Yong, Jeong, Woo-Jin, Kim, Ji-Won, Wee, Chan Woo, Wu, Hong-Gyun
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society for Radiation Oncology 01.12.2021; 대한방사선종양학회
• Subjects: Original; 방사선과학; Head and neck cancer; Re-irradiation; Intensity-modulated radiotherapy; Overall survival; Toxicity; Progression-free survival
• ISSN: 2234-1900; 2234-3156; 2234-3164
• DOI: 10.3857/roj.2021.00640

Purpose: To investigate the efficacy and safety of intensity-modulated radiotherapy (IMRT)-based re-irradiation (reRT) for recurrent or second primary head and neck cancer (HNC).Materials and Methods: Patients who underwent IMRT-based reRT for recurrent or second primary HNC between 2007 and 2019 at two institutions were included. Medical records and dosimetric data were retrospectively reviewed. Overall survival (OS), progression-free survival (PFS), severe late toxicities, and clinicopathological prognostic factors were analyzed.Results: A total of 42 patients were analyzed. With a median follow-up of 15.1 months (range, 3.7 to 85.8 months), the median OS was 28.9 months with a 2-year OS rate of 54.6%. The median PFS and 2-year PFS rates were 10.0 months and 30.9%, respectively. Multivariate analysis showed that good performance (Eastern Cooperative Oncology Group [ECOG] 0 or 1), a longer time interval (≥24 months) between radiotherapy courses, and higher reRT dose (>60 Gy) were significantly favorable factors for OS (all p < 0.05). Higher reRT dose and salvage surgery were significantly associated with improved PFS (all p < 0.05). Regarding the Multi‐Institution Reirradiation (MIRI) Collaborative RPA classification, the 2-year OS rates of each class were 87.5% in class I, 51.8% in class II, and 0% in class III (p = 0.008). Grade ≥3 late toxicity was reported in 10 (23.8%) patients. There was no significant factor associated with increased late toxicities.Conclusion: IMRT-based reRT should be considered as a treatment option for patients with recurrent or second primary HNC. Further trials are needed to establish a subset of patients who may benefit from reRT without severe late toxicity.