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

被引:87
作者
Takiar, Vinita [1 ]
Garden, Adam S. [2 ]
Ma, Dominic [2 ]
Morrison, William H. [2 ]
Edson, Mark [2 ]
Zafereo, Mark E. [3 ]
Gunn, Gary B. [2 ]
Fuller, Clifton D. [2 ]
Beadle, Beth [2 ]
Frank, Steven J. [2 ]
William, William N., Jr. [4 ]
Kies, Merrill [4 ]
El-Naggar, Adel K. [5 ]
Weber, Randal [3 ]
Rosenthal, David I. [2 ]
Jack Phan [2 ]
机构
[1] Univ Cincinnati, Dept Radiat Oncol, Cincinnati, OH USA
[2] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, 1515 Holcombe Blvd,Unit 0097, Houston, TX 77030 USA
[3] Univ Texas MD Anderson Canc Ctr, Dept Surg Oncol, 1515 Holcombe Blvd,Unit 0097, Houston, TX 77030 USA
[4] Univ Texas MD Anderson Canc Ctr, Dept Med Oncol, 1515 Holcombe Blvd,Unit 0097, Houston, TX 77030 USA
[5] Univ Texas MD Anderson Canc Ctr, Dept Pathol, 1515 Holcombe Blvd,Unit 0097, Houston, TX 77030 USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2016年 / 95卷 / 04期
关键词
SQUAMOUS-CELL CARCINOMA; 2ND PRIMARY HEAD; STEREOTACTIC RADIOSURGERY; NASOPHARYNGEAL CARCINOMA; CONCURRENT CHEMOTHERAPY; DISEASE-CONTROL; RECURRENT HEAD; ONCOLOGY-GROUP; PHASE-II; CISPLATIN;
D O I
10.1016/j.ijrobp.2016.03.015
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To review our 15-year institutional experience using intensity modulated radiation therapy (IMRT) to reirradiate patients with head and neck squamous cell carcinomas (HNSCC) and identify predictors of outcomes and toxicity. Methods and Materials: We retrospectively reviewed the records of 227 patients who received head and neck reirradiation using IMRT from 1999 to 2014. Patients treated with noncurative intent were excluded. Radiation-related acute and late toxicities were recorded. Prognostic variables included performance status, disease site, disease-free interval, chemotherapy, and RT dose and volume. Correlative analyses were performed separately for surgery and nonsurgery patients. Results: Two hundred six patients (91%) were retreated with curative intent, and 173 had HNSCC histology; 104 (50%) underwent salvage resection, and 135 (66%) received chemotherapy. Median follow-up after reirradiation was 24.7 months. Clinical outcomes were worse for HNSCC patients, with 5-year locoregional control, progression-free survival, and overall survival rates of 53%, 22%, and 32%, respectively, compared with 74%, 59%, and 79%, respectively, for non-HNSCC patients. On multivariate analysis, concurrent chemotherapy and retreatment site were associated with tumor control, whereas performance status was associated with survival. Favorable prognostic factors specific to surgery patients were neck retreatment and lack of extracapsular extension, whereas for nonsurgery patients, these were a nasopharynx subsite and complete response to induction chemotherapy. Actuarial rates of grade >= 3 toxicity were 32% at 2 years and 48% at 5 years, with dysphagia or odynophagia being most common. Increased grade >= 3 toxicity was associated with retreatment volume >50 cm(3) and concurrent chemotherapy. Conclusions: Reirradiation with IMRT either definitively or after salvage surgery can produce promising local control and survival in selected patients with head and neck cancers. Treatment-related toxicity remains significant. Prognostic factors are emerging to guide multidisciplinary treatment approaches and clinical trial design. (C) 2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:1117 / 1131
页数:15
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