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Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database

PURPOSE: Re-irradiation (re-RT) in head and neck cancer is challenging. This study prospectively explored the feasibility of re-RT in patients with loco-regionally recurrent or second primary head and neck cancer (LRR/SP HNC). METHODS: From 2004 to 2021, 61 LRR/SP HNC patients were treated with re-R...

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Autores principales: Scolari, Chiara, Buchali, André, Franzen, Achim, Förster, Robert, Windisch, Paul, Bodis, Stephan, Zwahlen, Daniel R., Schröder, Christina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10346436/
https://www.ncbi.nlm.nih.gov/pubmed/37456239
http://dx.doi.org/10.3389/fonc.2023.1175609
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author Scolari, Chiara
Buchali, André
Franzen, Achim
Förster, Robert
Windisch, Paul
Bodis, Stephan
Zwahlen, Daniel R.
Schröder, Christina
author_facet Scolari, Chiara
Buchali, André
Franzen, Achim
Förster, Robert
Windisch, Paul
Bodis, Stephan
Zwahlen, Daniel R.
Schröder, Christina
author_sort Scolari, Chiara
collection PubMed
description PURPOSE: Re-irradiation (re-RT) in head and neck cancer is challenging. This study prospectively explored the feasibility of re-RT in patients with loco-regionally recurrent or second primary head and neck cancer (LRR/SP HNC). METHODS: From 2004 to 2021, 61 LRR/SP HNC patients were treated with re-RT, defined as having a second course of RT with curative intent resulting in a cumulative dose of ≥100 Gy in an overlapping volume. Postoperative or definitive dynamic intensity-modulated and/or volumetric modulated re-RT was administered using twice daily hyperfractionation to 60 Gy combined with cisplatin or carboplatin/5-fluorouracil. Overall survival (OS), progression-free survival (PFS), locoregional control (LRC) and distant metastasis control (DMC) were analyzed and prognostic factors evaluated. Toxicity was prospectively recorded and graded. RESULTS: The median follow-up was 9.8 months. In 41 patients (67.1%), complete administration of the intended treatment was not feasible. In 9 patients (15%) re-RT was interrupted prematurely and in other 9, the complete re-RT dose was lower than 60 Gy, and 37 patients (61%) could not receive or complete chemotherapy. Two-year OS, PFS and LRC rates were 19%, 18% and 30%, respectively. 20 patients (33%) received the complete intended treatment, and 1- and 2-year OS rates were 70% and 47%, respectively. Charlson comorbidity index was an important predictor for treatment completion. Multivariate analysis revealed recurrent N stage 0–1, age, chemotherapy administration and re-RT dose of 60 Gy as prognostic factors for clinical outcomes. No grade 5 re-RT-related toxicity was observed. The most common new grade ≥3 acute toxicities were dysphagia (52%) and mucositis (46%). Late toxicity included grade ≥3 dysphagia in 5% and osteoradionecrosis in 10% of evaluable patients, respectively. 6 patients (10%) were alive after 9 years without progression and no late toxicity grade ≥3, except for 2 patients presenting with osteoradionecrosis. CONCLUSION: Hyperfractionated re-RT with 60 Gy combined with platinum-based chemotherapy was a curative treatment option with acceptable toxicity in LRR/SP patients. Patients with higher comorbidity had a higher probability of failing to receive and complete the intended therapy. Consequently, they derived unsatisfactory benefits from re-RT, highlighting the importance of patient selection.
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spelling pubmed-103464362023-07-15 Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database Scolari, Chiara Buchali, André Franzen, Achim Förster, Robert Windisch, Paul Bodis, Stephan Zwahlen, Daniel R. Schröder, Christina Front Oncol Oncology PURPOSE: Re-irradiation (re-RT) in head and neck cancer is challenging. This study prospectively explored the feasibility of re-RT in patients with loco-regionally recurrent or second primary head and neck cancer (LRR/SP HNC). METHODS: From 2004 to 2021, 61 LRR/SP HNC patients were treated with re-RT, defined as having a second course of RT with curative intent resulting in a cumulative dose of ≥100 Gy in an overlapping volume. Postoperative or definitive dynamic intensity-modulated and/or volumetric modulated re-RT was administered using twice daily hyperfractionation to 60 Gy combined with cisplatin or carboplatin/5-fluorouracil. Overall survival (OS), progression-free survival (PFS), locoregional control (LRC) and distant metastasis control (DMC) were analyzed and prognostic factors evaluated. Toxicity was prospectively recorded and graded. RESULTS: The median follow-up was 9.8 months. In 41 patients (67.1%), complete administration of the intended treatment was not feasible. In 9 patients (15%) re-RT was interrupted prematurely and in other 9, the complete re-RT dose was lower than 60 Gy, and 37 patients (61%) could not receive or complete chemotherapy. Two-year OS, PFS and LRC rates were 19%, 18% and 30%, respectively. 20 patients (33%) received the complete intended treatment, and 1- and 2-year OS rates were 70% and 47%, respectively. Charlson comorbidity index was an important predictor for treatment completion. Multivariate analysis revealed recurrent N stage 0–1, age, chemotherapy administration and re-RT dose of 60 Gy as prognostic factors for clinical outcomes. No grade 5 re-RT-related toxicity was observed. The most common new grade ≥3 acute toxicities were dysphagia (52%) and mucositis (46%). Late toxicity included grade ≥3 dysphagia in 5% and osteoradionecrosis in 10% of evaluable patients, respectively. 6 patients (10%) were alive after 9 years without progression and no late toxicity grade ≥3, except for 2 patients presenting with osteoradionecrosis. CONCLUSION: Hyperfractionated re-RT with 60 Gy combined with platinum-based chemotherapy was a curative treatment option with acceptable toxicity in LRR/SP patients. Patients with higher comorbidity had a higher probability of failing to receive and complete the intended therapy. Consequently, they derived unsatisfactory benefits from re-RT, highlighting the importance of patient selection. Frontiers Media S.A. 2023-06-29 /pmc/articles/PMC10346436/ /pubmed/37456239 http://dx.doi.org/10.3389/fonc.2023.1175609 Text en Copyright © 2023 Scolari, Buchali, Franzen, Förster, Windisch, Bodis, Zwahlen and Schröder https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Scolari, Chiara
Buchali, André
Franzen, Achim
Förster, Robert
Windisch, Paul
Bodis, Stephan
Zwahlen, Daniel R.
Schröder, Christina
Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database
title Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database
title_full Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database
title_fullStr Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database
title_full_unstemmed Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database
title_short Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database
title_sort re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10346436/
https://www.ncbi.nlm.nih.gov/pubmed/37456239
http://dx.doi.org/10.3389/fonc.2023.1175609
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