Treatment of stage I nasopharyngeal carcinoma: Analysis of the patterns of relapse and the results of withholding elective neck irradiation (original) (raw)
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Medpulse International Journal of Radiology, 2018
Background: We report our experience with patients who received re-irradiation to the head and neck area for locoregional recurrences (LRR) or second primaries (SP) in a previously irradiated field. Methods: We reviewed 27 consecutive patients with a diagnosis of LRR or SP head and neck carcinoma treated with a second course of radiotherapy between April 2004 and July 2012. The main outcome measures were local control, overall survival, and complications. The results are expressed as actuarial values using the Kaplan-Meier estimates. Results: The median follow-up time was 24.7 months (range: 11 days-79.3 months). There were 23 males and four females with a median age of 61 years (range: 40-87 years). The actuarial overall survival rates at 1, 2, and 5 years were 77, 59, and 57 %, respectively. The actuarial local control rate was 80, 52, and 52 % at 1, 2, and 5 years, respectively. Three patients developed systemic metastases. The rate of grade 3 toxicity was 26 %, and that of grade 4 toxicity was 3 %. There were two treatment-related deaths (grade 5 toxicity). Conclusions: Continuous course re-irradiation in patients with LRR or SP head and neck cancer is feasible with acceptable toxicity. With current encouraging rates of local control and overall survival, this option should be discussed with patients who have few alternative therapeutic options.
Journal of Otolaryngology - Head & Neck Surgery, 2015
Background: We report our experience with patients who received re-irradiation to the head and neck area for locoregional recurrences (LRR) or second primaries (SP) in a previously irradiated field. Methods: We reviewed 27 consecutive patients with a diagnosis of LRR or SP head and neck carcinoma treated with a second course of radiotherapy between April 2004 and July 2012. The main outcome measures were local control, overall survival, and complications. The results are expressed as actuarial values using the Kaplan-Meier estimates. Results: The median follow-up time was 24.7 months (range: 11 days-79.3 months). There were 23 males and four females with a median age of 61 years (range: 40-87 years). The actuarial overall survival rates at 1, 2, and 5 years were 77, 59, and 57 %, respectively. The actuarial local control rate was 80, 52, and 52 % at 1, 2, and 5 years, respectively. Three patients developed systemic metastases. The rate of grade 3 toxicity was 26 %, and that of grade 4 toxicity was 3 %. There were two treatment-related deaths (grade 5 toxicity). Conclusions: Continuous course re-irradiation in patients with LRR or SP head and neck cancer is feasible with acceptable toxicity. With current encouraging rates of local control and overall survival, this option should be discussed with patients who have few alternative therapeutic options.
Initial experience using intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma
International Journal of Radiation Oncology*Biology*Physics, 2004
The average time to the nasopharyngeal recurrence was 30.2 months after initial conventional RT. The median isocenter dose to the nasopharynx was 70 Gy (range 60.9 -78.0) for the initial conventional RT. All patients were restaged at the time of recurrence according to the 1992 Fuzhou, China staging system on NPC. The number of patients with Stage I, II, III and IV disease was 4, 9, 10, and 26, respectively. T1, T2, T3, and T4 disease was found in 4, 9, 11, and 25 patients, respectively. N0, N1, N2, and N3 disease was found in 46, 2, 0, and 1 patient, respectively. Invasion of the nasal cavity, maxillary sinus, ethmoid sinus, sphenoid sinus, and cavernous sinus and erosion of the base of the skull was found in 8, 1, 3, 8, 15, and 20 patients, respectively. The gross tumor volume (GTV) was contoured according to the International Commission on Radiation Units and Measurements (ICRU) Report 62 guidelines. The critical structures were contoured, and the doses to critical structures were constrained according to ICRU 50 guidelines. The GTV in the nasopharynx and positive lymph nodes in the neck received a prescription dose of 68 -70 Gy and 60 Gy, respectively. All patients received full-course IMRT. Three patients who had positive lymph nodes were treated with five to six courses of chemotherapy (cisplatin ؉ 5-fluorouracil) after IMRT. Results: The treatment plans showed that the percentage of GTV receiving 95% of the prescribed dose (V 95-GTV ) was 98.5%, and the dose encompassing 95% of GTV (D 95-GTV ) was 68.1 Gy in the nasopharynx. The mean dose to the GTV was 71.4 Gy. The average doses of the surrounding critical structures were much lower than the tolerable thresholds. At a median follow-up of 9 months (range 3-13), the locoregional control rate was 100%. Three cases (6.1%) of locoregional residual disease were seen at the completion of IMRT, but had achieved a complete response at follow-up. Three patients developed metastases at a distant site: two in the bone and one in the liver and lung at 13 months follow-up. Acute toxicity (skin, mucosa, and xerostomia) was acceptable according to the Radiation Therapy Oncology Group criteria. Tumor necrosis was seen toward the end of IMRT in 14 patients (28.6%). Conclusion: The improvement in tumor target coverage and significant sparing of adjacent critical structures allow the feasibility of IMRT as a retreatment option for recurrent NPC after initial conventional RT. This is the first large series using IMRT to reirradiate local recurrent NPC after initial RT failed. The treatment-related toxicity profile was acceptable. The initial tumor response/local control was also very encouraging. In contrast to primary NPC, recurrent NPC reirradiated with high-dose IMRT led to the shedding of tumor necrotic tissue toward the end of RT. More patients and longer term follow-up are warranted to evaluate late toxicity and treatment outcome.
Challenges in the re-irradiation of locally advanced head and neck cancers: outcomes and toxicities
Journal of Radiation Oncology, 2019
Purpose To retrospectively review outcomes and toxicities for patients with recurrent head and neck cancer (HNC) undergoing re-irradiation (re-RT). Methods Retrospective review of oncologic outcomes and toxicity data from patients who received head and neck (HN) re-RT with curative intent using intensity-modulated radiation therapy (IMRT) from 2011 to 2016. Common toxicities were scored using Common Terminology Criteria for Adverse Events (CTCAE) V4. Treatment outcomes included progression-free survival (PFS), locoregional control (LRC), and overall survival (OS). Results Twenty-one patients with HNC were re-irradiated with curative intent. The median follow-up after re-RT was 27.8 months. The median retreatment dose was 66 Gy (range, 60-70), and the median retreatment volume was 194.1 cm 3 (range, 52.4-1375.6). The median LRC, PFS, and OS were 10 months, 8.4 months, and 18.1 months, respectively. Patients treated with surgery as a component of primary HN cancer treatment had significantly worse PFS and OS when retreated compared with those initially treated with chemoradiation alone (p = 0.026 and p = 0.005, respectively). Those with stage IVA/B recurrent disease had worse LRC, PFS, and OS compared with stage II/III disease (p = 0.029, p = 0.049, and p = 0.020 respectively). Acute grade ≥ 3 toxicity and late grade ≥ 3 toxicity were 38% and 38%, respectively, with dysphagia being most common (24% acute and 14% late). Conclusion Re-irradiation with IMRT for locally advanced HN recurrences either definitively or after salvage surgery is feasible, but treatment-related toxicity remains significant. Patients who received surgery as a component of their initial treatment and those with more advanced stage disease may be more difficult to salvage with re-irradiation.
Outcome after Re-Irradiation of Head and Neck Cancer Patients
Strahlentherapie und Onkologie, 2010
Purpose: To retrospectively report the outcome of head and neck cancer patients following re-irradiation. Patients and Methods: A total of 51 patients with recurrent or second primary head and neck cancer received re-irradiation at Leuven University Hospital. Survival and locoregional control were calculated. Doses to organs at risk were retrieved from dosevolume histograms. Radiation-related toxicities were reported. Results: The 2-year actuarial overall survival rate was 30%. On univariate analysis, surgery before re-irradiation and high radiation dose were associated with superior survival. Grade 3 acute and grade 3 or more late toxicity occurred in respectively 29.4% and 35.3% of the patients. Conclusion: Re-irradiation in head and neck cancer patients is feasible with acceptable late toxicity, although the survival remains poor.
Complications following re-irradiation for head and neck cancer
American Journal of Otolaryngology, 2002
Purpose: Re-irradiation may induce serious complications because of overdosage to previously irradiated areas. A few reports do exist that describe the incidence and factors related to late complications. In the present study we analyze complications following re-irradiation for head and neck cancers. Materials and Methods: Between 1984 and 1998, 91 patients presenting with squamous cell carcinoma of the head and neck were re-irradiated with a total dose of 80-144 Gy and overlap fields of 4-128 cm 2 . Re-irradiation was administered exclusively with external beam irradiation with conventional (n ϭ 47), hyper-(n ϭ 10), or hypofractionation (n ϭ 34). Chemotherapy was combined with the initial course of irradiation (n ϭ 34) or re-irradiation (n ϭ 18). Follow-up time ranged from 3 to 84 months. Results: Severe acute reactions occurred in 6.6% of patients. Moreover, incidence was significantly higher (40%) in elderly patients older than 80 years. Severe late complications developed 3-10 months after re-irradiation. The incidence was 13% in 78 patients followed for more than 3 months and 21% in 42 patients with tumor-free status. The complications were observed in 19% of patients previously receiving locoregional irradiation, compared with those receiving local irradiation alone (0%), and in 20% of patients undergoing re-irradiation to the neck, compared with those receiving re-irradiation to the head (3%). These factors were all significant by multivariate analysis. Radiation dose, fractionation method, and overlap area were not significant. Conclusion: Care should be exercised with respect to the potential for acute complications in elderly patients and late complications in those patients having previously received locoregional irradiation and re-irradiation to the neck. (Am J Otolaryngol 2002;23:215-221.
A review on re-irradiation for recurrent and second primary head and neck cancer
Oral Oncology, 2005
The purpose of this paper is to review the results of studies regarding radiation as primary or adjuvant treatment modality for head and neck recurrences or second primary tumours (SPT) in previously irradiated areas, with emphasis on acute and late radiation induced morbidity, locoregional control and survival.
BMC Cancer, 2012
Background: The aim of the study is to assess the effectiveness of intensity-modulated radiotherapy (IMRT) or image-guided radiotherapy (IGRT) for the prevention of retropharyngeal nodal recurrences in locally advanced head and neck cancer. Methods: A retrospective review of 76 patients with head and neck cancer undergoing concurrent chemoradiation or postoperative radiotherapy with IMRT or IGRT who were at risk for retropharyngeal nodal recurrences because of anatomic site (hypopharynx, nasopharynx, oropharynx) and/or the presence of nodal metastases was undertaken. The prevalence of retropharyngeal nodal recurrences was assessed on follow-up positron emission tomography (PET)-CT scans. Results: At a median follow-up of 22 months (4-53 months), no patient developed retropharyngeal nodal recurrences. Conclusion: Prophylactic irradiation of retropharyngeal lymph nodes with IMRT or IGRT provides effective regional control for individuals at risk for recurrence in these nodes.
Annals of Oncology, 2011
Background: This study describes the results of elective irradiation in the N0 neck and tries to identify prognostic factors for regional recurrence. Materials and methods: Between 1985 and 2000, 785 cN0 or pN0 necks were treated with elective nodal irradiation in 619 head and neck squamous cell carcinoma patients. Results: Regional control at 3 years was 94% in the cN0 (nondissected) neck compared with 97% in the pN0 (dissected) neck and 90% in the ipsilateral compared with 96% in the contralateral neck (P = 0.08 and P = 0.006, respectively). Regional control in the ipsilateral cN0 neck was 78% compared with 96% in the contralateral cN0 neck. Surgical margin of the primary tumor was an additional prognostic factor in all N0 and pN0 necks. Conclusions: Neck control rates in electively irradiated N0 necks were excellent. Regional control was worse in the cN0 neck compared with the pN0 neck and in the ipsilateral neck compared with the contralateral side. Additionally, in case of positive surgical margins of the primary tumor, elective nodal irradiation should be applied, even in case of a pN0 neck.