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Chen AM, Harris JP, Nabar R, Tjoa T, Haidar Y, Armstrong WB. Re-irradiation versus systemic therapy for the management of local-regionally recurrent head and neck cancer. Radiother Oncol 2024; 196:110278. [PMID: 38636710 DOI: 10.1016/j.radonc.2024.110278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/25/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE The optimal management of local-regionally recurrent head and neck cancer that is not amenable to surgical resection is uncertain. We sought to compare outcomes among patients treated with and without re-irradiation in this setting. METHODS AND MATERIALS A review of institutional registries identified 65 patients with local-regionally recurrent squamous cell carcinoma of the head and neck who were ineligible for surgery. Forty patients (62 %) opted for re-irradiation with the remaining 25 patients (38 %) undergoing initial systemic therapy alone. All patients had measurable disease. Forty-three patients (66 %) were male and twenty-two (33 %) were female. The median age at the time of recurrence was 59 years (range, 39-84 years). The most common primary sites of disease were the oropharynx, (n = 25), oral cavity (N = 19), and nasopharynx (n = 11). The median interval from completion of prior radiation to the diagnosis of recurrent disease was 35 months (range, 2-102 months). RESULTS Re-irradiation improved 2-year overall survival, (32 % versus 11 %), progression-free survival (31 % versus 7 %), and local-regional control (39 % versus 3 %) compared to systemic therapy alone (p < 0.05, for both). The likelihood of developing any new grade 3+ toxicity was significantly higher among patients treated by re-irradiation compared to those treated by systemic therapy (53 % vs. 28 %, p < 0.001). There were 3 treatment-related fatalities, all of which occurred in the re-irradiation group. The incidence of grade 3+ late toxicity was 48 % and 12 % for patients in the re-irradiation and systemic therapy cohorts, respectively (p < 0.001). CONCLUSION Although re-irradiation improved overall survival compared to systemic therapy for appropriately selected patients with local-regionally recurrent head and neck cancer, the relatively high risk of toxicity must be considered.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States.
| | - Jeremy P Harris
- Department of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States
| | - Rupali Nabar
- Department of Internal Medicine, Division of Hematology-Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States
| | - Tjoson Tjoa
- Department of Otolaryngology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States
| | - Yarah Haidar
- Department of Otolaryngology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States
| | - William B Armstrong
- Department of Otolaryngology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States
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Alterio D, Zaffaroni M, Bossi P, Dionisi F, Elicin O, Falzone A, Ferrari A, Jereczek-Fossa BA, Sanguineti G, Szturz P, Volpe S, Scricciolo M. Reirradiation of head and neck squamous cell carcinomas: a pragmatic approach, part II: radiation technique and fractionations. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01671-0. [PMID: 37415056 DOI: 10.1007/s11547-023-01671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/25/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Reirradiation (reRT) of local recurrent/second primary tumors of the head and neck represents a potential curative treatment for patients not candidate to a salvage surgery. Aim of the present study is to summarize literature data on modern radiation techniques and fractionations used in this setting of patients. MATERIALS AND METHODS A narrative review of the literature was conducted on three topics: (1) target volume delineation (2) reRT dose and techniques and (3) ongoing studies. Patients treated with postoperative reRT and palliative intent were not considered for the current analysis. RESULTS Recommendations on the target volume contouring have been reported. 3D-Conformal Radiotherapy, Intensity Modulated Radiotherapy, Stereotactic body Radiotherapy Intraoperative Radiotherapy, Brachytherapy and Charged Particles have been analyzed in terms of indication and fractionation in the field of reRT. Ongoing studies on the topic have been reported for IMRT and Charged Particles. Moreover, according to literature data a stepwise approach has been proposed aiming to provide a useful tool to select patients candidate to a curative reRT in daily clinical practice. Two clinical cases were also provided for its application. CONCLUSION Different radiation techniques and fractionations can be used for a second course of radiotherapy in patients with recurrent/second primary tumor of head and neck region. Tumor characteristics as well as radiobiological considerations should be take into account to define the best reRT approach.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Francesco Dionisi
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Falzone
- Unità Operativa Multizonale di Radiologia Ospedale di Rovereto e Arco, Azienda Sanitaria per i Servizi Provinciali di Trento, Trento, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Sanguineti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Petr Szturz
- Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Haque S, Karivedu V, Riaz MK, Choi D, Roof L, Hassan SZ, Zhu Z, Jandarov R, Takiar V, Tang A, Wise-Draper T. High-risk pathological features at the time of salvage surgery predict poor survival after definitive therapy in patients with head and neck squamous cell carcinoma. Oral Oncol 2018; 88:9-15. [PMID: 30616803 DOI: 10.1016/j.oraloncology.2018.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/20/2018] [Accepted: 11/07/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Salvage surgical resection is the preferred treatment for head and neck squamous cell carcinoma (HNSCC) patients who develop locally recurrent disease after failing primary therapy. However, salvage surgical resection is not always feasible, and survival outcomes for those that do undergo salvage remain poor. It is well known that patients with adverse pathological features (extracapsular extension (ECE) of lymph nodes (LN), positive margins, perineural invasion (PNI), lymphovascular invasion (LVI), and multiple LN metastases) at the time of primary surgical resection are likely to have relatively poor outcomes. However, the impact of adverse pathological features on outcomes in the salvage setting remains controversial. MATERIALS AND METHODS We retrospectively analyzed 73 patients at a single institution from 2008 to 2017 who developed recurrence and subsequently underwent salvage surgery (SS) after definitive curative-intent therapy including radiation. Demographic and disease control outcomes were reviewed. Kaplan-Meier curves were used to estimate relapse free survival (RFS) and overall survival (OS). RESULTS Median age at diagnosis was 61 years (range 40-86), 49/73 (67%) were male, and 55/73 (75%) had smoked. Patients with any adverse pathological features at SS had worse RFS (HR 3.15 p = 0.0008) and worse OS (3.97 p = 0.0008). Patients who relapsed <6 months after initial therapy had worse OS (HR 2.96 p = 0.004). CONCLUSIONS Patients with adverse pathological features at time of salvage surgery as well as those who have an early recurrence after definitive treatment and salvage surgery have worse outcomes. Prospective studies are necessary to clarify which patients should receive more intense treatment at salvage.
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Affiliation(s)
- Sulsal Haque
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vidhya Karivedu
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Muhammed K Riaz
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David Choi
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Logan Roof
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sarah Z Hassan
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Zheng Zhu
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Roman Jandarov
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alice Tang
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Trisha Wise-Draper
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Factors Affecting Survival in Surgically Salvaged Locoregional Recurrences of Squamous Cell Carcinoma of the Tongue. J Oral Maxillofac Surg 2018; 76:1133.e1-1133.e6. [DOI: 10.1016/j.joms.2017.12.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/30/2017] [Accepted: 12/30/2017] [Indexed: 01/09/2023]
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