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Additional radiotherapy safe, effective for recurrent head, neck cancer
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Continuous course re-irradiation appeared safe and feasible for patients with head and neck cancers who experienced locoregional recurrences or second primary malignancies in previously irradiated fields, according to the results of a retrospective study.
“Surgical resection is typically considered the modality of choice in patients with locoregional recurrences (LRR) or second primary (SP) head and neck cancer who were previously treated with a full dose of radiation therapy,” Rolina Al-Wassia, MBBS, assistant professor of radiation oncology at King Abdulaziz University in Jeddah, Saudi Arabia, and colleagues wrote. “In the last decade, re-irradiation has begun to gain conceptual acceptance, as experimental and clinical studies have demonstrated that high-dose re-irradiation can be administered with reasonable success and acceptable complication rates.”
Al-Wassia and colleagues conducted a retrospective review of 27 patients (median age, 61 years; 85% men) diagnosed with LRR or SP head and neck carcinoma treated with additional radiotherapy concurrently with chemotherapy between April 2004 and July 2012.
OS, local control and complications served as the primary outcomes.
Median follow-up was 24.7 months (range, 11 days–79.3 months). The median maximal dose delivered to the spinal cord during treatment was 15.5 Gy (range, 6-45), to the brain stem was 20 Gy (range, 1-63) and to the mandible was 63 Gy (range, 5-75).
The population had an actuarial OS rate of 77% at 1 year, 59% at 2 years and 57% at 5 years. The actuarial local control rate was 80% at 1 year and 52% at 2 years and 52% at 5 years.
Nineteen patients (70%) achieved a complete response, four patients (15%) achieved a partial response and one patient (4%) had no response. Two patients (7%) experienced progressive disease and one patient had insufficient follow-up.
At the time of follow-up, 14 patients (52%) had no evidence of failure, whereas four patients (15%) had local failure, three (11%) had regional failure, two (7%) had locoregional failure, two (7%) had second primaries and two (7%) had persistent disease.
Three patients developed systemic metastases, one of whom died during treatment.
Twenty-six percent of patients experienced grade 3 adverse events and 3% of patients experienced grade 4 adverse events. Two patients died of treatment-related grade 5 adverse events: one as a result of carotid rupture and one related to mucosal bleeding.
The researchers acknowledged limitations of their study, including the small sample size and the lack of concurrent systemic treatment in 12% of patients.
“Our results reinforce the emerging view in the scientific community that re-irradiation with concomitant chemotherapy for LRR or SP in a region that previously received high-dose irradiation is feasible, and it produces good local control and chances of long-term survival,” Al-Wassia and colleagues wrote. “The care of these patients requiring re-irradiation to the head and neck region is complex and should be carried out by centers where necessary multidisciplinary expertise and support are available.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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