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. 2017 Jun;39(6):1122-1130.
doi: 10.1002/hed.24733. Epub 2017 Mar 6.

Reirradiation of head and neck cancer: Long-term disease control and toxicity

Wouter T C Bots  1 , Sven van den Bosch  1 , Ellen M Zwijnenburg  1 , Tim Dijkema  1 , Guido B van den Broek  2 , Willem L J Weijs  3 , Lia C G Verhoef  1 , Johannes H A M Kaanders  1
Affiliations

Reirradiation of head and neck cancer: Long-term disease control and toxicity

Wouter T C Bots et al. Head Neck. 2017 Jun.

Abstract

Background: The purpose of this study was to report long-term disease control and late radiation toxicity for patients reirradiated for head and neck cancer.

Methods: We conducted a retrospective analysis of 137 patients reirradiated with a prescribed dose ≥45 Gy between 1986 and 2013 for a recurrent or second primary malignancy. Endpoints were locoregional control, overall survival (OS), and grade ≥4 late complications according to European Organization for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) criteria.

Results: Five-year locoregional control rates were 46% for patients reirradiated postoperatively versus 20% for patients who underwent reirradiation as the primary treatment (p < .05). Sixteen cases of serious (grade ≥4) late toxicity were seen in 11 patients (actuarial 28% at 5 years). In patients reirradiated with intensity-modulated radiotherapy (IMRT), a borderline improved locoregional control was observed (49% vs 36%; p = .07), whereas late complication rates did not differ.

Conclusion: Reirradiation should be considered for patients with a recurrent or second primary head and neck cancer, especially postoperatively, if indicated. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1122-1130, 2017.

Keywords: disease control; head and neck cancer; intensity-modulated radiotherapy (IMRT); late toxicity; reirradiation.

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Figures

Figure 1
Figure 1
(A) Distribution of cumulative re‐irradiation dose (n = 137). (B) Distribution of reirradiation overlap areas.
Figure 2
Figure 2
(A) Overall survival with 95% confidence interval (CI). (B) Overall locoregional control with 95% CI. (C) Overall disease‐free survival with 95% CI.
Figure 3
Figure 3
(A) Overall survival in primary tumor and postoperative (post‐op) reirradiation (re‐RT) with 95% confidence interval (CI). (B) Locoregional control in primary tumor and postoperative reirradiation with 95% CI. (C) Locoregional control in patients reirradiated with intensity‐modulated radiotherapy (IMRT) versus conventional techniques with 95% CI.
Figure 4
Figure 4
Event‐free survival with 95% confidence interval
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