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Re-irradiation Using Intensity-modulated Radiotherapy for Recurrent and Second Primary Head and Neck Cancer

 Seo Hee Choi  ;  Jee Suk Chang  ;  Jinhyun Choi  ;  So Hyun Park  ;  Ki Chang Keum  ;  Kyung Ran Park  ;  Chang Geol Lee 
 ANTICANCER RESEARCH, Vol.38(5) : 3165-3173, 2018 
Journal Title
Issue Date
Adult ; Aged ; 80 and over Aged ; Disease-Free Survival ; Female ; Head and Neck Neoplasms/mortality/*radiotherapy ; Humans ; Male ; Middle Aged ; Local/mortality/pathology/radiotherapy Neoplasm Recurrence ; Intensity-Modulated Radiotherapy ; Re-Irradiation/adverse effects/*methods ; Retrospective Studies ; Young Adult
Head and neck cancer ; radiotherapy ; re-irradiation ; salvage therapy
BACKGROUND/AIM: Information on re-irradiation (re-RT) for recurrent and second primary head and neck cancer is limited. Herein, a description of our long-term experience of re-RT for previously irradiated head and neck cancer is provided. MATERIALS AND METHODS: A retrospective review was performed for 73 consecutive patients re-irradiated for head and neck cancer between 2006 and 2015. Re-RT targets encompassed only the recurrent gross tumor and had tight margins (5-10 mm). RESULTS: Salvage surgery was performed on 28 (38%) patients before re-RT and 53 (73%) patients received chemotherapy concurrent with re-RT. The median interval between initial and re-RT was 31 months and the median cumulative dose of the two irradiations was 126 Gy (biologically equivalent to 2 Gy fractionation). With a median survival of 33 months, locoregional recurrence after re-RT developed in 37 patients (51%; 25 infield, 12 outfield). In multivariate analysis, higher re-RT dose (>/=66 Gy), longer time interval (>2 years), and use of concurrent chemotherapy were associated with improved locoregional recurrence-free survival (all p<0.05). Additionally, performance status, additional surgical resection, and longer interval were associated with better overall survival (p=0.006, 0.021, 0.004, respectively). Clinically significant acute and late toxicities occurred in 14% and 22% of evaluable patients, but no grade 5 toxicity was observed. CONCLUSION: Moderate safety and acceptable toxicity was found after re-RT using tight margins, sufficient radiation dose, and daily image guidance. Encouraging local control and survival were obtained, similar to historical data using 1-2 cm margins.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Lee, Chang Geol(이창걸) ORCID logo https://orcid.org/0000-0002-8702-881X
Chang, Jee Suk Paul(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
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