Journal Article

The value of moderate dose escalation for re-irradiation of recurrent or second primary head-and-neck cancer

Laszig, Roland, Sprave, Tanja, Nicolay, Nils H., Grosu, Anca-Ligia, Rühle, Alexander, Kalckreuth, Tobias, Haehl, Erik, Stoian, Raluca, Zamboglou, Constantinos, Knopf, Andreas

2020

Overview

Background Treatment for local and locoregional recurrence or second head-and-neck (H&N) cancers after previous radiotherapy is challenging, and re-irradiation carries a significantly increased risk for radiotherapy-related normal tissue toxicities and treatment failure due to a radioresistant tumor phenotype. Here, we analyzed re-irradiation management and outcomes in patients with recurrent or second primary H&N carcinoma using state-of-the-art diagnostic procedures and radiotherapy techniques. Methods Between 2010 and 2019, 48 patients with recurrent or second primary H&N carcinoma received re-radiotherapy at the University of Freiburg Medical Center and were included in this study. Overall survival (OS) and progression-free survival (PFS) were calculated with the Kaplan-Meier method, and univariate Cox-regression analyses were performed to assess the effects of clinico-pathological factors on treatment outcomes. Acute and chronic treatment-related toxicities were quantified using the Common Terminology Criteria for Adverse Events (CTCAE v4.03). Results Thirty-one patients (64.6%) received definitive and 17 (35.4%) adjuvant radiotherapy. Simultaneous chemotherapy was administered in 28 patients (58.3%) with cetuximab as the most commonly used systemic agent ( n  = 17, 60.7%). After a median time of 17 months (range 4 months to 176 months) between first and second radiotherapy, patients were re-irradiated with a median of 58.4 Gy and a treatment completion rate of 87.5% ( n  = 42). Median OS was 25 months with a 1-year OS amounting to 62.4%, and median PFS was 9 months with a 1-year PFS of 37.6%. Univariate analyses demonstrated that both a lower rT-status and a radiotherapy boost were associated with improved OS ( p  < 0.05). There was a trend towards superior OS for patients who received > 50 Gy ( p  = 0.091) and who completed the prescribed radiotherapy ( p  = 0.055). Five patients (10.4%) suffered from at least one grade 3 toxicities, while 9 patients (27.3%) experienced chronic higher-grade toxicities (≥ grade 3) with one (3.0%) grade 4 carotid blowout and one (3.0%) grade 4 osteoradionecrosis. Conclusion Re-irradiation of recurrent or second primary H&N cancer with modern radiation techniques such as intensity-modulated radiotherapy resulted in promising survival rates with acceptable toxicities compared to historical cohorts. Increased re-irradiation doses, utilization of a radiotherapy boost and completion of the re-irradiation treatment were found to result in improved survival.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Aged, 80 and over / Biomedical and Life Sciences / Biomedical materials / Biomedicine / Cancer / Cancer recurrence / Cancer Research / Cancer therapies / Care and treatment / Cetuximab - therapeutic use / Chemotherapy / Chemotherapy, Adjuvant / Clinical Radiation Oncology / Diagnostic systems / Failure analysis / Female / Head & neck cancer / Head and neck cancer / Head and Neck Neoplasms - diagnosis / Head and Neck Neoplasms - drug therapy / Head and Neck Neoplasms - radiotherapy / Head and Neck Neoplasms - surgery / Head-and-neck squamous cell carcinoma (HNSCC) / Health care facilities / Humans / Imaging / Irradiation / Male / Medical diagnosis / Medical prognosis / Metastasis / Methods / Middle Aged / Monoclonal antibodies / Neoplasm Recurrence, Local - diagnosis / Neoplasm Recurrence, Local - drug therapy / Neoplasm Recurrence, Local - radiotherapy / Neoplasm Recurrence, Local - surgery / Neoplasms, Second Primary - diagnosis / Neoplasms, Second Primary - drug therapy / Neoplasms, Second Primary - radiotherapy / Neoplasms, Second Primary - surgery / Oncology / Osteoradionecrosis / Pathology / Patient outcomes / Patients / Phenotypes / Planning / Progression-Free Survival / Radiation / Radiation dosage / Radiation Injuries - epidemiology / Radiation Injuries - etiology / Radiation therapy / Radiology / Radiotherapy / Radiotherapy Dosage / Radiotherapy, Adjuvant / Radiotherapy, Image-Guided / Re-irradiation / Re-Irradiation - adverse effects / Re-Irradiation - methods / Re-Irradiation - mortality / Recurrent head-and-neck cancer / Regression analysis / Retrospective Studies / Squamous cell carcinoma / Surgery / Survival / Survival Rate / Targeted cancer therapy / Terminology / Toxicity / Tumors / Ultrasonic imaging