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Buciuman N, Marcu LG. Dosimetric and clinical aspects of head and neck cancer reirradiation with intensity modulated radiotherapy techniques over the last decade. Phys Med 2023; 112:102650. [PMID: 37556868 DOI: 10.1016/j.ejmp.2023.102650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Tumor recurrence in head and neck cancer (HNC) is very common, given that locoregional disease relapse occurs in up to 50% of patients. The clinical approach towards cancer recurrence is either by surgery and/or chemo-radiotherapy. Irrespective of the treatment, the management of HNC recurrence is highly challenging and often administered with palliative intent only. The aim of this work was to analyze clinical and dosimetric aspects, such as dose prescription, organ at risk sparing, overall survival and locoregional control of HNC after reirradiation with intensity modulated radiotherapy techniques based on studies published over the last decade, due to the wide clinical implementation of the intensity modulated radiotherapy and particularly of volumetric modulated arc therapy (VMAT) for this malignancy. METHODS A systematic search of the literature was conducted within Pub-med/Medline databases to find relevant studies. Of the 130 articles fulfilling the initial search criteria, 15 were selected for final analysis that encompassed all set requirements. RESULTS Clinical studies revealed the multitude of factors influencing treatment outcome, including anatomical location, histological tumor type, patient-related factors (smoking / comorbidities), cumulative dose and fractionation schedule, reirradiated volume and time between the irradiation of primary and recurrent tumor. CONCLUSIONS Since the literature reports no specific data related to the type of intensity modulation used in reirradiation or any correlation with treatment outcome, IMRT and VMAT might offer comparable result after HNC reirradiation. Patient selection is potentially the main factor leading to an efficient outcome.
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Affiliation(s)
- Nikolett Buciuman
- Faculty of Physics, West University of Timisoara, Timisoara, Romania; OncoHelp Foundation, Timisoara, Romania
| | - Loredana G Marcu
- Faculty of Physics, West University of Timisoara, Timisoara, Romania; Faculty of Informatics & Science, University of Oradea, Oradea, Romania; UniSA Allied Health & Human Performance, University of South Australia, Adelaide SA 5001, Australia.
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Wang LW, Liu YWH, Chu PY, Liu HM, Peir JJ, Lin KH, Huang WS, Lo WL, Lee JC, Lin TY, Liu YM, Yen SH. Boron Neutron Capture Therapy Followed by Image-Guided Intensity-Modulated Radiotherapy for Locally Recurrent Head and Neck Cancer: A Prospective Phase I/II Trial. Cancers (Basel) 2023; 15:2762. [PMID: 37345099 DOI: 10.3390/cancers15102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND This trial investigated the efficacy and safety of salvage boron neutron capture therapy (BNCT) combined with image-guided intensity-modulated radiotherapy (IG-IMRT) for recurrent head and neck cancer after prior radiotherapy (RT). METHODS BNCT was administered using an intravenous boronophenylalanine-fructose complex (500 mg/kg) in a single fraction; multifractionated IG-IMRT was administered 28 days after BNCT. For BNCT, the mucosa served as the dose-limiting organ. For IG-IMRT, the clinical target volume (CTV) and the planning target volume (PTV) were generated according to the post-BNCT gross tumor volume (GTV) with chosen margins. RESULTS This trial enrolled 14 patients, and 12 patients received combined treatment. The median BNCT average dose for the GTV was 21.6 Gy-Eq, and the median IG-IMRT dose for the PTV was 46.8 Gy/26 fractions. After a median (range) follow-up period of 11.8 (3.6 to 53.2) months, five patients had a complete response and four had a partial response. One patient had grade 4 laryngeal edema; another patient had a grade 4 hemorrhage. Most tumor progression occurred within or adjacent to the CTV. The 1-year overall survival and local progression-free survival rates were 56% and 21%, respectively. CONCLUSION Despite the high response rate (64%) of this trial, there was a high incidence of in-field and marginal failure with this approach. Future studies combining BNCT with modalities other than radiation may be tried.
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Affiliation(s)
- Ling-Wei Wang
- Department of Heavy Ion and Radiation Oncology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Section 2, Li-Nong Street, Taipei 112304, Taiwan
| | - Yen-Wan Hsueh Liu
- Heron Neutron Medical Corporation, No. 66-2, Shengyi 5th Road, Zhubei City 30261, Taiwan
| | - Pen-Yuan Chu
- School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Section 2, Li-Nong Street, Taipei 112304, Taiwan
- Department of Otolaryngology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
| | - Hong-Ming Liu
- Nuclear Science and Technology Development Center, National Tsing Hua University, No. 101, Sect 2, Kuang Fu Road, Hsinchu 30013, Taiwan
| | - Jinn-Jer Peir
- Nuclear Science and Technology Development Center, National Tsing Hua University, No. 101, Sect 2, Kuang Fu Road, Hsinchu 30013, Taiwan
| | - Ko-Han Lin
- School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Section 2, Li-Nong Street, Taipei 112304, Taiwan
- Department of Nuclear Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
| | - Wen-Sheng Huang
- Department of Nuclear Medicine, Cheng Hsin General Hospital, No. 45, Cheng Hsin Street, Taipei 11220, Taiwan
| | - Wen-Liang Lo
- Department of Stomatology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
- School of Dentistry, National Yang-Ming Chiao Tung University, No. 155, Section 2, Li-Nong Street, Taipei 112304, Taiwan
| | - Jia-Cheng Lee
- Department of Heavy Ion and Radiation Oncology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
| | - Tzung-Yi Lin
- Heron Neutron Medical Corporation, No. 66-2, Shengyi 5th Road, Zhubei City 30261, Taiwan
| | - Yu-Ming Liu
- Department of Heavy Ion and Radiation Oncology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Section 2, Li-Nong Street, Taipei 112304, Taiwan
| | - Sang-Hue Yen
- Division of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Shing-Long Road, Taipei 116, Taiwan
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Li Y, Jiang Y, Qiu B, Sun H, Wang J. Current radiotherapy for recurrent head and neck cancer in the modern era: a state-of-the-art review. J Transl Med 2022; 20:566. [PMID: 36474246 PMCID: PMC9724430 DOI: 10.1186/s12967-022-03774-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In the management of head and neck cancer (HNC) patients, local recurrence is a common cause of treatment failure. Only a few patients with recurrent HNC (rHNC) are eligible for salvage surgery and the majority of patients receive systemic therapy and radiotherapy. In recent years, with the development of irradiation technology, radiotherapy for rHNC patients has markedly attracted clinicians' attention and its therapeutic effects on patients with end-stage cancer are worthy of investigation as well. METHODS Several studies have investigated the role of radiotherapy in the treatment of rHNC patients. We reviewed retrospective reports and prospective trials published in recent decades that concentrated on the management of rHNC. RESULTS A growing body of evidence supported the application of irradiation to rHNC patients. According to the results of this review, current radiotherapy could achieve a better efficacy with a lower incidence of toxicity. CONCLUSION Radiotherapy is a promising treatment for rHNC patients.
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Affiliation(s)
- Yue Li
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 China
| | - Yuliang Jiang
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 China
| | - Bin Qiu
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 China
| | - Haitao Sun
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 China
| | - Junjie Wang
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 China
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4
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Beddok A, Saint‐Martin C, Krhili S, Eddine CA, Champion L, Chilles A, Goudjil F, Zefkili S, Amessis M, Peurien D, Choussy O, le Tourneau C, Dendale R, Buvat I, Créhange G, Calugaru V. Curative high‐dose reirradiation for patients with recurrent head and neck squamous cell carcinoma using IMRT or proton therapy: Outcomes and analysis of patterns of failure. Head Neck 2022; 44:2452-2464. [DOI: 10.1002/hed.27153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Arnaud Beddok
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
- PSL Research University, University Paris Saclay, Inserm LITO U1288 Institut Curie Orsay France
| | | | - Samar Krhili
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | | | | | - Anne Chilles
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Farid Goudjil
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Sofia Zefkili
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Malika Amessis
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Dominique Peurien
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Olivier Choussy
- Department of Head and Neck Surgery Institut Curie Paris France
| | - Christophe le Tourneau
- Department of Drug Development and Innovation (D3i), INSERM U900 Research unit Paris‐Saclay University. Institut Curie Paris France
| | - Remi Dendale
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Irene Buvat
- PSL Research University, University Paris Saclay, Inserm LITO U1288 Institut Curie Orsay France
| | - Gilles Créhange
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Valentin Calugaru
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
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Bhattacharyya T, Koto M, Windisch P, Ikawa H, Hagiwara Y, Tsuji H, Adeberg S. Emerging Role of Carbon Ion Radiotherapy in Reirradiation of Recurrent Head and Neck Cancers: What Have We Achieved So Far? Front Oncol 2022; 12:888446. [PMID: 35677171 PMCID: PMC9167994 DOI: 10.3389/fonc.2022.888446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Administering reirradiation for the treatment of recurrent head and neck cancers is extremely challenging. These tumors are hypoxic and radioresistant and require escalated radiation doses for adequate control. The obstacle to delivering this escalated dose of radiation to the target is its proximity to critical organs at risk (OARs) and possible development of consequent severe late toxicities. With the emergence of highly sophisticated technologies, intensity-modulated radiotherapy (IMRT) and stereotactic body radiotherapy have shown promising outcomes. Proton beam radiotherapy has been used for locally recurrent head and neck cancers because of its excellent physical dose distribution, exploring sharp Bragg peak properties with negligible entrance and exit doses. To further improve these results, carbon ion radiotherapy (CIRT) has been explored in several countries across Europe and Asia because of its favorable physical properties with minimal entrance and exit doses, sharper lateral penumbra, and much higher and variable relative biological efficacy, which cannot be currently achieved with any other form of radiation. Few studies have described the role of CIRT in recurrent head and neck cancers. In this article, we have discussed the different aspects of carbon ions in reirradiation of recurrent head and neck cancers, including European and Asian experiences, different dose schedules, dose constraints of OARs, outcomes, and toxicities, and a brief comparison with proton beam radiotherapy and IMRT.
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Affiliation(s)
- Tapesh Bhattacharyya
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, India
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Masashi Koto
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Paul Windisch
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Hiroaki Ikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Yasuhito Hagiwara
- Department of Radiation Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Sebastian Adeberg
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Heidelberg (UKHD), Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), UKHD and DKFZ, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
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6
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Ward MC, Koyfman SA, Bakst RL, Margalit DN, Beadle BM, Beitler JJ, Chang SSW, Cooper JS, Galloway TJ, Ridge JA, Robbins JR, Sacco AG, Tsai CJ, Yom SS, Siddiqui F. Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC): Expert Panel on Radiation Oncology - Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2022; 113:759-786. [PMID: 35398456 DOI: 10.1016/j.ijrobp.2022.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Re-treatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice. METHODS We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method. RESULTS The final number of citations retained for review was 274. These informed five key questions, which focused on patient selection, adjuvant re-irradiation, definitive re-irradiation, stereotactic body radiation (SBRT), and re-irradiation to treat non-squamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence. CONCLUSIONS This provides updated evidence-based recommendations and guidelines for the re-treatment of recurrent or second primary cancer of the head and neck.
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Affiliation(s)
- Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.
| | | | | | - Danielle N Margalit
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Beth M Beadle
- Stanford University School of Medicine, Palo Alto, California
| | | | | | | | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jared R Robbins
- University of Arizona College of Medicine Tucson, Tucson, Arizona
| | - Assuntina G Sacco
- University of California San Diego Moores Cancer Center, La Jolla, California
| | - C Jillian Tsai
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sue S Yom
- University of California, San Francisco, California
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7
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Multidisciplinary Management of Radiation-Induced Salivary Gland Carcinomas in the Modern Radiotherapy Era. Cancers (Basel) 2020; 12:cancers12123769. [PMID: 33327563 PMCID: PMC7765068 DOI: 10.3390/cancers12123769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Etiopathogenesis of salivary gland cancers [SGCs] is largely unknown, even if exposition to ionizing radiation is a recognized risk factor for SGCs development. To date, exhaustive data to guide clinicians in managing patients with radiation-induced [ri] SGCs are scarce and their treatment remains challenging. The purpose of this work is to describe and to analyze clinical and histopathological features, delivered treatments, and outcome of a series of patients with ri-SGCs treated at two Italian cancer referral sites. Given the rarity of ri-SGCs, this retrospective analysis conducted on a case series of 13 patients adds further knowledge to the paucity of literature. The management of these malignancies is extremely complex requiring a multidisciplinary treatment approach. Abstract Clinical data of ri-SGCs patients treated between 2015 and 2019 at a tertiary cancer center and a national hadron therapy facility were reviewed. Latent time (LT) from first RT to ri-SGCs diagnosis, overall (OS), and disease-free survival (DFS) were assessed. Thirteen patients developed 14 ri-SGCs (one patient had 2 synchronous ri-SCGs), after a median LT of 23 years (range 16–34). Parotid was the primary site in 8 cases (57%) and salivary duct carcinoma was the most frequent histotype (29%). Nine patients (69%) underwent surgery (Sx). Among them, 4 patients (31%) underwent Sx alone, 5 received post-operative treatments: 3 (23%) photon-based (X) reRT, one (8%) protons and carbon ions, one (8%) carbon ions only. One patient (8%) received definitive XRT. The remaining 3 patients (23%) received androgen deprivation therapy. With a median follow-up of 48 months (range 24–72), median OS and PFS were 74 and 24 months, respectively. In the subgroup of AR+ ri-SGCs, median PFS and OS were 12 and 74 months, respectively. Given the rarity of ri-SGCs, this work adds further knowledge to the paucity of literature. The management of these malignancies is extremely complex requiring a multidisciplinary treatment approach.
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8
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Lee J, Shin IS, Kim WC, Yoon WS, Koom WS, Rim CH. Reirradiation with intensity-modulated radiation therapy for recurrent or secondary head and neck cancer: Meta-analysis and systematic review. Head Neck 2020; 42:2473-2485. [PMID: 32437021 DOI: 10.1002/hed.26264] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/14/2020] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To summarize outcomes of reirradiation with intensity-modulated radiotherapy (IMRT) for recurrent or secondary head and neck cancer (HNC). METHODS Primary endpoints were 2-year local control (LC) and overall survival (OS). Studies involving only recurrent nasopharyngeal patients with cancer were excluded. RESULTS A total of 17 studies involving 1635 patients were included. Fourteen (82%) of those were retrospective, and 15 (88%) were from single institution. Reirradiation with IMRT produced pooled 2-year LC and OS rates of 52% (95% confidence interval [CI], 46%-57%) and 46% (95% CI, 41%-50%), respectively. In subgroup analyses, the rate of salvage surgery (<42% vs ≥42%) influenced the pooled 2-year LC rate (45.9% vs 58.5%, P = .011). The pooled rates of late grade ≥ 3 and grade 5 toxicities were 26% (95% CI, 20%-32%) and 3.1% (95% CI, 2%-5%), respectively. CONCLUSIONS Reirradiation with IMRT was an effective modality compared to historical outcomes in the pre-IMRT era.
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Affiliation(s)
- Jeongshim Lee
- Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea.,Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - In-Soo Shin
- Graduate School of Education, Dongguk University, Seoul, South Korea
| | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, South Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, South Korea
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Abstract
Along with chemotherapy, surgery and immunotherapy, radiotherapy is a mainstay of cancer treatment. Considering the improving survival rates for various malignancies during the past decades, the importance of radiation-induced late normal tissue response is increasing. Quality of life is becoming an important issue in modern cancer treatment and is correlated with acute and late normal tissue response after radiotherapy. A profound understanding of radiation-induced normal tissue response is necessary to sufficiently diagnose and treat radiation-induced side effects and thereby increase the patients' quality of life. Here, the various normal tissue responses in consideration of the radiation biology are specified and prospective options to attenuate radiation-induced side effects are discussed.
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Affiliation(s)
- A Rühle
- Abteilung für RadioOnkologie und Strahlentherapie, Universitätsklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,KKE Molekulare und RadioOnkologie, Deutsches Krebsforschungszentrum (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - P E Huber
- Abteilung für RadioOnkologie und Strahlentherapie, Universitätsklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland. .,KKE Molekulare und RadioOnkologie, Deutsches Krebsforschungszentrum (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland.
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A Practical Radiotherapy Treatment Planning Technique for Second-Incidence Cancers That Incorporates Complete Organ-At-Risk Dose History. J Med Imaging Radiat Sci 2018; 50:74-81. [PMID: 30777252 DOI: 10.1016/j.jmir.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patients requiring treatment for second cancer incidences present unique radiotherapy plan development challenges. Historical dose delivered to organs at risk must be accounted for to properly estimate lifetime toxicity risks, but historical dose delivered to the region now occupied by tumours does not contribute to the prescription dose. Treatment planning systems permit inclusion of a base plan but do not provide the ability to manipulate it. We present a technique, dose cropping, which incorporates organ-at-risk dose history into the base plan while selectively excising dose history to diseased tissues now occupied by tumours. A retrospective plan comparison is performed to assess the effectiveness of dose cropping. METHODS AND MATERIALS Nine patients who received a second course of radiotherapy for cancers of the head-and-neck were replanned using the proposed technique. Clinical second courses and replans were compared on the basis of conformity index, heterogeneity index, maximum point dose, tissue control probability (TCP), normal tissue complication probability (NTCP), and whether the planning guidelines could be met by the treatment planning system. Replan constraints and guidelines followed the clinical treatment. In addition, a tissue recovery model was incorporated, applied to both clinical and replan courses, and compared to estimate the relevance of the dose cropping technique in such regimes. RESULTS AND DISCUSSION Replans had reduced organ-at-risk maximum point doses (5 Gy for spinal cord, 4 Gy for brainstem), NTCP (2.9% median reduction), and were able to more consistently achieve the V95% > 98% coverage target regardless of the tissue recovery model. At the same time, replans using the dose cropping technique were statistically indistinguishable from clinical second courses on the basis of plan conformity, heterogeneity, or TCP (P > .31 in all cases). CONCLUSIONS Dosimetric history cropping is a valuable and widely applicable technique for second cancer radiotherapy planning. It also provides a natural means to incorporate tissue recovery models, biologically effective dose conversion, and NTCP and TCP model evaluation.
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11
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Re-irradiation as salvage treatment in recurrent glioblastoma: A comprehensive literature review to provide practical answers to frequently asked questions. Crit Rev Oncol Hematol 2018; 126:80-91. [PMID: 29759570 DOI: 10.1016/j.critrevonc.2018.03.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 02/11/2018] [Accepted: 03/28/2018] [Indexed: 02/06/2023] Open
Abstract
The primary aim of this review is to provide practical recommendations in terms of fractionation, dose, constraints and selection criteria to be used in the daily clinical routine. Based on the analysis of the literature reviewed, in order to keep the risk of severe side effects ≤3,5%, patients should be stratified according to the target volume. Thus, patients should be treated with different fractionation and total EQD2 (<12.5 ml: EQD2 < 65 Gy with radiosurgery; >12.5 ml and <35 ml: EQD2 < 50 Gy with hypofractionated stereotactic radiotherapy; >35 ml and <50 ml: EQD2 < 36 Gy with conventionally fractionated radiotherapy). Concurrent approaches with temozolomide or bevacizumab do not seem to improve the outcomes of reirradiation and may lead to a higher risk of toxicity but these findings need to be confirmed in prospective series.
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12
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Kinj R, Bénézery K, Florescu C, Gery B, Habrand JL, Thariat J. [Re-irradiation of head and neck cancers: Target volumes, technical evolutions and prospects]. Cancer Radiother 2018; 22:171-179. [PMID: 29428789 DOI: 10.1016/j.canrad.2017.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/02/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022]
Abstract
Malignant tumors of the head and neck have a predominantly regional recurrence pattern, with most deaths resulting from this progression. Optimization of re-radiation in recurrence setting is a major objective for these patients. Extensive research has been carried out with the PubMed search engine to find publications dealing with this topic. The first attempts to reirradiate the ORL sphere date back to the 1980s and the first to be performed by intensity modulation conformational radiotherapy (IMRT) date back to the late 1990s. Compared to 3 dimensional conformal radiotherapy, IMRT improves clinical outcomes and reduces toxicity. In IMRT series, associated or not with concomitant chemotherapy, the locoregional control obtained at 2 years was of the order of 45 to 65% and the overall survival of 15 to 60%, depending on predictive factors. Grade 3 acute toxicity occurred on the order of 10 to 30% and late-grade 3 toxicity on the order of 15 to 50%. In a selected population with low volumes tumors, stereotactic re-irradiation at a minimum dose of 35Gy obtained outcome comparable to IMRT. Re-irradiation of head and neck tumors by proton therapy is rare. The toxicity rate appears to be lower than that usually seen after photon therapy. However, we do not have a long follow-up. This technique therefore remains reserved for search protocols and represents a future perspective in these situations.
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Affiliation(s)
- R Kinj
- Service de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France.
| | - K Bénézery
- Service de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France
| | - C Florescu
- Service de radiothérapie, centre de lutte contre le cancer François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - B Gery
- Service de radiothérapie, centre de lutte contre le cancer François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - J L Habrand
- Service de radiothérapie, centre de lutte contre le cancer François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - J Thariat
- Service de radiothérapie, centre de lutte contre le cancer François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
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Stanisce L, Koshkareva Y, Xu Q, Patel A, Squillante C, Ahmad N, Rajagopalan K, Kubicek GJ. Stereotactic Body Radiotherapy Treatment for Recurrent, Previously Irradiated Head and Neck Cancer. Technol Cancer Res Treat 2018; 17:1533033818780086. [PMID: 29890894 PMCID: PMC6024262 DOI: 10.1177/1533033818780086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Locally recurrent, previously irradiated primary head and neck tumors have historically been associated with poor outcomes. Stereotactic body radiation therapy has emerged as a feasible and promising treatment option for tumor recurrence, particularly in nonsurgical candidates. This study aimed to assess the associated outcomes of stereotactic body radiation therapy used in this setting. Methods: Retrospective analysis of a prospectively collected database of 25 patients treated with CyberKnife for unresectable, recurrent head and neck cancer in a previously irradiated field. The primary end points evaluated were rates of survival, tumor control, and treatment-related toxicities. Results: Median survival of the study population was 7.5 months (range, 1.5-47.0 months). Median survival of the 20 (80%) patients who were treated with curative purpose was 8.3 months. One-year overall survival rate for the entire population was 32%. The respective 1-year and 2-year survival rates for the curative subcohort were 40% and 20%, respectively. Local and locoregional failure occurred in 8 (32%) and 7 (28%) patients, respectively. Low severe acute (4%) and late (6%) treatment-related toxicity rates were observed. No grade 4 or 5 toxicities were observed. Conclusion: Stereotactic body radiation therapy is a viable treatment option for patients with unresectable, recurrent head and neck cancer. Significant tumor control rates are achievable with minimal severe toxicity. Although perhaps associated with patient selection and a heterogeneous sample, overall survival of stereotactic body radiation therapy outcomes appears unfavorable.
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Affiliation(s)
- Luke Stanisce
- 1 Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Yekaterina Koshkareva
- 2 Department of Otolaryngology-Head and Neck Surgery, MD Anderson Cancer Center at Cooper University, Camden, NJ, USA
| | - Qianyi Xu
- 3 Department of Radiation Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
| | - Ashish Patel
- 3 Department of Radiation Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
| | - Christian Squillante
- 4 Department of Medical Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
| | - Nadir Ahmad
- 2 Department of Otolaryngology-Head and Neck Surgery, MD Anderson Cancer Center at Cooper University, Camden, NJ, USA
| | - Kumar Rajagopalan
- 4 Department of Medical Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
| | - Gregory J Kubicek
- 3 Department of Radiation Oncology, MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, USA
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Facteurs pronostiques de la ré-irradiation des cancers des voies aérodigestives supérieures : revue de la littérature. Cancer Radiother 2017; 21:316-338. [DOI: 10.1016/j.canrad.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/06/2017] [Accepted: 02/27/2017] [Indexed: 11/19/2022]
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15
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Benson R, Giridhar P, Venkatesulu BP, Mallick S, Raza MW, Rath GK. Re-irradiation for head and neck squamous cell carcinoma. J Egypt Natl Canc Inst 2017; 29:1-9. [DOI: 10.1016/j.jnci.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/22/2016] [Accepted: 07/24/2016] [Indexed: 12/22/2022] Open
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16
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Guimas V, Thariat J, Graff-Cailleau P, Boisselier P, Pointreau Y, Pommier P, Montbarbon X, Laude C, Racadot S. Radiothérapie conformationnelle avec modulation d’intensité des cancers des voies aérodigestives supérieures, dose de tolérance des tissus sains : appareil cochléovestibulaire et tronc cérébral. Cancer Radiother 2016; 20:475-83. [DOI: 10.1016/j.canrad.2016.07.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 12/25/2022]
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17
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Orlandi E, Iacovelli NA, Bonora M, Cavallo A, Fossati P. Salivary Gland. Photon beam and particle radiotherapy: Present and future. Oral Oncol 2016; 60:146-56. [PMID: 27394087 DOI: 10.1016/j.oraloncology.2016.06.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 12/12/2022]
Abstract
Salivary gland cancers (SGCs) are rare diseases and their treatment depends upon histology, stage and site of origin. Radical surgery is the mainstay of treatment but radiotherapy (RT) plays a key role in both the postoperative and the inoperable setting, as well as in recurrent disease. In the absence of prospective randomized trials, a wide retrospective literature suggests postoperative RT (PORT) in patients with high risk pathological features. SGCs, and adenoid cystic carcinoma (ACC) in particular, are known to be radio-resistant tumors and should therefore respond well to particle beam therapy. Recently, excellent outcome has been reported with radical carbon ion RT (CIRT) in particular for ACC. Both modern photon- and hadron-based treatments are effective and are characterized by a favourable toxicity profile. But it is not clear whether one modality is superior to the other for disease control, due to the differences in patients' selection, techniques, fractionation schedules and outcome measurements among clinical experiences. In this paper, we review the role of photon and particle RT for malignant SGCs, discussing the difference between modalities in terms of biological and technical characteristics. RT dose and target volumes for different histologies (ACC versus non-ACC) have also been taken into consideration.
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Affiliation(s)
- Ester Orlandi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | | | - Maria Bonora
- Clinical Department, CNAO (National Center for Oncological Hadrontherapy), Pavia, Italy
| | - Anna Cavallo
- Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Piero Fossati
- Clinical Department, CNAO (National Center for Oncological Hadrontherapy), Pavia, Italy; Radiotherapy Division, European Institute of Oncology, Milan, Italy
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18
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Garg S, Kilburn JM, Lucas JT, Randolph D, Urbanic JJ, Hinson WH, Kearns WT, Porosnicu M, Greven K. Reirradiation for second primary or recurrent cancers of the head and neck: Dosimetric and outcome analysis. Head Neck 2015; 38 Suppl 1:E961-9. [PMID: 25993910 DOI: 10.1002/hed.24136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine outcomes, toxicity, and dosimetric characteristics of patients treated with reirradiation for head and neck cancers. METHODS Fifty patients underwent ≥2 courses of radiation therapy (RT) postoperatively or definitively with or without chemotherapy. Composite dose volume histograms (DVHs) for selected anatomic structures were correlated with grade ≥3 late toxicity. RESULTS Median initial and retreatment radiation dose was 64 and 60 Gy, respectively. Median overall survival (OS), progression-free survival (PFS), and 1-year PFS rates were 18 months, 11 months, and 45%, respectively, with 13 months median follow-up. Thirty-four percent of patients experienced grade ≥3 late toxicity with 1 death from carotid blowout. The DVH corresponding to the carotid blowout fell above the third quartile compared with other patients. CONCLUSION Our analysis is the first to systematically evaluate the dose to the carotid artery using composite dosimetry in head and neck reirradiation patients, and demonstrates a promising technique for evaluating the dose to other normal tissue structures. © 2015 Wiley Periodicals, Inc. Head Neck 38: E961-E969, 2016.
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Affiliation(s)
- Shivank Garg
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jeremy M Kilburn
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John T Lucas
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David Randolph
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James J Urbanic
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William H Hinson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William T Kearns
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mercedes Porosnicu
- Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn Greven
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Lo CH, Huang WY, Lin KT, Lin MJ, Lin TP, Jen YM. Repeated stereotactic ablative radiotherapy using CyberKnife for patients with hepatocellular carcinoma. J Gastroenterol Hepatol 2014; 29:1919-25. [PMID: 25041220 DOI: 10.1111/jgh.12659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM This study aimed to evaluate the outcomes and toxicities of repeated stereotactic ablative radiotherapy (SABR) in hepatocellular carcinoma (HCC). METHODS Fourteen HCC patients with local recurrence (18 lesions) after liver SABR received repeated radiotherapy with SABR using CyberKnife. No patients experienced radiation-induced liver disease after the first SABR course. The median first SABR dose was 41 Gy (range, 34-60 Gy); the median second SABR dose, 40 Gy (range, 25-50 Gy); and the median interval, 12.9 months. Local recurrence was divided into in-field recurrence and out-field recurrence. RESULTS Objective responses were observed in 11 tumors (61.1%), including five tumors (27.8%) with complete responses. Intrahepatic out-field failure was the main cause of treatment failure (7 of 14 patients). In-field failure had developed in 1 of 18 tumors (5.6%), resulting in a 2-year in-field failure-free rate of 88.2%. The median time to progression was 14.0 months, with 1- and 2-year progression-free survival rates of 68.6% and 42.9%, respectively. One- and two-year overall survival rates were 76% and 59.1%, respectively. Of the 14 patients, one developed radiation-induced liver disease and three showed progression of the Child-Turcotte-Pugh class after the second SABR course. Other toxicities were generally mild and tolerable. CONCLUSION Repeated SABR in selected HCC patients is feasible with acceptable toxicity.
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Affiliation(s)
- Cheng-Hsiang Lo
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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20
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Re-irradiation in head and neck cancers: an Indian tertiary cancer centre experience. The Journal of Laryngology & Otology 2014; 128:996-1002. [DOI: 10.1017/s0022215114002497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To explore the treatment outcomes of patients treated with re-irradiation for recurrent or second primary head and neck cancer.Method:An analysis was performed of 79 head and neck cancer patients who underwent re-irradiation for second primaries or recurrent disease from January 1999 to December 2011.Results:Median time from previous radiation to re-irradiation for second primary or recurrence was 53.6 months (range, 2.7–454.7 months). Median age at diagnosis of first primary was 54 years. Median re-irradiation dose was 45 Gy (range, 45–60 Gy). Acute grade 3 or worse toxicity was seen in 30 per cent of patients. Median progression-free survival for recurrent disease was 15.0 months (95 per cent confidence interval, 8.33–21.66). The following factors had a statistically significant, positive impact on progression-free survival: patient age of less than 50 years (median progression-free survival was 29.43, vs 13.9 months for those aged 50 years or older; p = 0.004) and disease-free interval of 2 years or more (median progression-free survival was 51.66, vs 13.9 months for those with less than 2 years disease-free interval).Conclusion:Re-irradiation of second primaries or recurrences of head and neck cancers with moderate radiation doses yields acceptable progression-free survival and morbidity rates.
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21
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Strojan P, Corry J, Eisbruch A, Vermorken JB, Mendenhall WM, Lee AWM, Haigentz M, Beitler JJ, de Bree R, Takes RP, Paleri V, Kelly CG, Genden EM, Bradford CR, Harrison LB, Rinaldo A, Ferlito A. Recurrent and second primary squamous cell carcinoma of the head and neck: when and how to reirradiate. Head Neck 2014; 37:134-50. [PMID: 24481720 DOI: 10.1002/hed.23542] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/22/2013] [Accepted: 10/30/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Local and/or regional recurrence and metachronous primary tumor arising in a previously irradiated area are rather frequent events in patients with head and neck squamous cell carcinoma (HNSCC). Re-treatment is associated with an increased risk of serious toxicity and impaired quality of life (QOL) with an uncertain survival advantage. METHODS We analyzed the literature on the efficacy and toxicity of photon/electron-based external beam reirradiation for previously irradiated patients with HNSCC of non-nasopharyngeal origin. Studies were grouped according to the radiotherapy technique used for reirradiation. Patient selection criteria, target volume identification method, tumor dose, fractionation schedule, systemic therapy administration, and toxicities were reviewed. RESULTS In addition to disease-related factors, current comorbidities and preexisting organ dysfunction must be considered when selecting patients for reirradiation. As morbidity from re-treatment may be considerable and differ depending on which mode of re-treatment is used, it is important to give patients information on potential morbidity outcomes so that an informed choice can be made within a shared decision-making context. With improved dose distribution and adequate imaging support, including positron emission tomography-CT, modern radiotherapy techniques may improve local control and reduce toxicity of reirradiation. A reirradiation dose of ≥60 Gy and a volume encompassing the gross tumor with up to a 5-mm margin are recommended. Concomitant administration of systemic therapeutics and reirradiation is likely to be of similar benefit as observed in large randomized studies of upfront therapy. CONCLUSION Reirradiation, administered either with or without concurrent systemic therapy, is feasible and tolerable in properly selected patients with recurrent or a new primary tumor in a previously irradiated area of the head and neck, offering a meaningful survival (in the range of 10% to 30% at 2 years). Whenever feasible, salvage surgery is the method of choice for curative intent; patients at high-risk for local recurrence should be advised that postoperative reirradiation is expected to increase locoregional control at the expense of higher toxicity and without survival advantage compared to salvage surgery without reirradiation. © 2014 Wiley Periodicals, Inc. Head Neck 37: 134-150, 2015.
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Affiliation(s)
- Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
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22
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Farace P, Piras S, Porru S, Massazza F, Fadda G, Solla I, Piras D, Deidda MA, Amichetti M, Possanzini M. Preventive sparing of spinal cord and brain stem in the initial irradiation of locally advanced head and neck cancers. J Appl Clin Med Phys 2014; 15:4399. [PMID: 24423836 PMCID: PMC5711237 DOI: 10.1120/jacmp.v15i1.4399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 10/02/2013] [Accepted: 08/30/2013] [Indexed: 11/23/2022] Open
Abstract
Since reirradiation in recurrent head and neck patients is limited by previous treatment, a marked reduction of maximum doses to spinal cord and brain stem was investigated in the initial irradiation of stage III/IV head and neck cancers. Eighteen patients were planned by simultaneous integrated boost, prescribing 69.3 Gy to PTV1 and 56.1 Gy to PTV2. Nine 6 MV coplanar photon beams at equispaced gantry angles were chosen for each patient. Step‐and‐shoot IMRT was calculated by direct machine parameter optimization, with the maximum number of segments limited to 80. In the standard plan, optimization considered organs at risk (OAR), dose conformity, maximum dose <45 Gy to spinal cord and <50 Gy to brain stem. In the sparing plans, a marked reduction to spinal cord and brain stem were investigated, with/without changes in dose conformity. In the sparing plans, the maximum doses to spinal cord and brain stem were reduced from the initial values (43.5±2.2 Gy and 36.7±14.0 Gy), without significant changes on the other OARs. A marked difference (−15.9±1.9 Gy and −10.1±5.7 Gy) was obtained at the expense of a small difference (−1.3%±0.9%) from initial PTV195% coverage (96.6%±0.9%). Similar difference (−15.7±2.2 Gy and −10.2±6.1 Gy) was obtained compromising dose conformity, but unaffecting PTV195% and with negligible decrease in PTV295% (−0.3%±0.3% from the initial 98.3%±0.8%). A marked spinal cord and brain stem preventive sparing was feasible at the expense of a decrease in dose conformity or slightly compromising target coverage. A sparing should be recommended in highly recurrent tumors, to make potential reirradiation safer. PACS number: 87.55.D
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Soltys B, Wiazzane N, Mirjolet C, Dalban C, Serre AA, Zanetta S, Thiebaut S, Créhange G, Maingon P. [Reirradiations of head and neck cancers: state of the concept and ways of development]. Cancer Radiother 2013; 17:508-12. [PMID: 23999251 DOI: 10.1016/j.canrad.2013.07.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/12/2013] [Indexed: 11/28/2022]
Abstract
The treatment of local recurrence or second primary developed in irradiated area in the field of head and neck carcinoma, should be planned and organized through multidisciplinary discussions. The outcome of such a clinical situations benefits from second line and advanced technology treatments. Only a few patients are amenable to salvage surgery, hence radiation therapy, combined or not with chemotherapy, takes a major role in these indications. This overview of the literature describes recent development in this field, aiming to improve local control while the sparing of organ at risk remains an important goal. Radiation therapy is currently implementing major new technologies set to improve external beam irradiation with new concepts on dose, fractionation, intensity modulated radiation therapy and stereotactic approach - as well as in brachytherapy. Apart from dedicated studies, the great heterogeneity of the treated patients should be underlined and taken into consideration. However, current data confirm the feasibility of reirradiation with acceptable local control and toxicity.
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Affiliation(s)
- B Soltys
- Département de radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21079 Dijon, France
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Meijneke TR, Petit SF, Wentzler D, Hoogeman M, Nuyttens JJ. Reirradiation and stereotactic radiotherapy for tumors in the lung: dose summation and toxicity. Radiother Oncol 2013; 107:423-7. [PMID: 23647748 DOI: 10.1016/j.radonc.2013.03.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/20/2013] [Accepted: 03/24/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess the accumulated dose and the toxicity after reirradiation for tumors in the lung using non-rigid registration. MATERIAL AND METHODS Twenty patients with a tumor in the lung were reirradiated with or after stereotactic radiotherapy. The summed dose distribution was calculated using non-rigid registration. All doses were recalculated to an equivalent dose of 2 Gy per fraction (EQD2). The median follow-up time was 12 months (range 2-52). RESULTS The median Dmax of the lung in the summed plans was 363 Gy3 (range 123-590). The median accumulated V20 of the lungs was 15.2%. Seven patients had in the heart and the trachea an accumulated dose ≥70 Gy3, with a median D(max) of the heart of 115 Gy3 and 89 Gy3 for the trachea. Eight patients had in the esophagus an accumulated dose ≥70 Gy3, with a median accumulated dose of 85 Gy3. No grade 3-5 toxicity was observed. CONCLUSION Reirradiation of the lung with or after stereotactic radiotherapy is feasible to a median Dmax of 363 Gy3 to the lung, as low toxicity was observed.
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Affiliation(s)
- Thomas R Meijneke
- Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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25
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Wong SJ, Bourhis J, Langer CJ. Retreatment of Recurrent Head and Neck Cancer in a Previously Irradiated Field. Semin Radiat Oncol 2012; 22:214-9. [DOI: 10.1016/j.semradonc.2012.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kurzweg T, Möckelmann N, Laban S, Knecht R. Current treatment options for recurrent/metastatic head and neck cancer: a post-ASCO 2011 update and review of last year's literature. Eur Arch Otorhinolaryngol 2012; 269:2157-67. [PMID: 22437252 DOI: 10.1007/s00405-012-1998-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
The majority of patients with a squamous cell carcinoma of the head and neck present with locally advanced tumors. The first-line treatment of locally advanced tumor stages consists of a combined modality management. Despite these aggressive protocols, many patients develop locoregional recurrences or metastasis and place particularly high demands on the interdisciplinary treatment team. Treatment with a curative intent must be differentiated from a palliative one. In addition to prior treatment, resectability, age and performance status, patient wishes must be taken into consideration in treatment planning, especially considering that most therapies offer little to no overall survival benefit. Salvage surgery, chemo- and target therapies, and reirradiation are head and neck surgeon's and radiooncologist's weapons in the fight against these strong opponents. This review focuses on publications and meeting news from last year and reviews the current status of the clinical application of each treatment modality in recurrent or metastatic head and neck cancer.
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Affiliation(s)
- T Kurzweg
- Department of Otolaryngology and Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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