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Feasibility of reirradiation and treatment outcome in a previously irradiated territory in head-and-neck malignancies

Abstract

Introduction

Despite combined modality treatment, local persistent or recurrent disease is a primary cause of treatment failure in 30–50% of patients with advanced head-and-neck cancer (HNC). The role of reirradiation is feared because of increased risk of toxicity due to the previously irradiated target volume. In the present study, we have evaluated reirradiation by image-guided intensity-modulated radiotherapy in recurrent and second primary HNCs and its outcome.

Materials and methods

In all, 24 patients with recurrence or second primary tumors in HNC were included in the study conducted between January 2009 to August 2014. All patients were treated by the image-guided intensity-modulated radiotherapy technique. The most common site of recurrence/second primary was oral tongue. The time interval between initial radiotherapy and reirradiation ranged from 8 months to 17 years.

Statistical analysis used

The association between qualitative variables was tested using the χ2-test. Statistical significance was interpreted using an arbitrary cut-off of P=0.05. Kaplan–Meier Survival graph was plotted to depict the survival pattern of the study patients.

Results

The planning target volume volume of reirradiation ranged from 26.72 to 469.32 ml (median: 118.71 ml). Toxicity was more in patients receiving concurrent chemoradiation and in patients with less interval time between reirradiation. Out of the 24 patients, nine were no evidence of disease, eight patients expired (five disease progression, two comorbidities, and one due to hematemesis after the development of third primary), two recurred, one developed distant metastases, and four were lost to follow-up.

Conclusion

Surgical resection, with or without reirradiaton, provides the highest likelihood for successful salvage in locoregional (LR) recurrences in HNCs. Patients reirradiated after a long time from initial irradiation have better tolerance.

References

  1. 1

    Lefebvre JL, Rolland F, Tesselaar M, Bardet E, Leemans CR, Geoffrois L, et al. Phase 3 randomized trial on larynx preservation comparing sequential vs alternating chemotherapy and radiotherapy. J Natl Cancer Inst 2009; 101:142–152.

    CAS  Article  Google Scholar 

  2. 2

    Schwartz LH, Ozsahin M, Zhang GN, Touboul E, De Vataire F, Andolenko P, et al. Synchronous and metachronous head and neck carcinomas. Cancer 1994; 74:1933–1938.

    CAS  Article  Google Scholar 

  3. 3

    Goodwin JrWJ. Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aero digestive tract: when do the ends justify the means? Laryngoscope 2000; 110:1–18.

    Article  Google Scholar 

  4. 4

    Browman GP, Cronin L. Standard chemotherapy in squamous cell head and neck cancer: what we have learned from randomized trials. Semin Oncol 1994; 21:311–319.

    CAS  PubMed  Google Scholar 

  5. 5

    Duprez F, Madani I, Bonte K, Boterberg T, Vakaet L, Derie C, et al. Intensity-modulated radiotherapy for recurrent and second primary head and neck cancer in previously irradiated territory. Radiother Oncol 2009; 93:563–569.

    Article  Google Scholar 

  6. 6

    Warren S, Gates O. Multiple primary malignant tumors: a survey of the literature and statistical study. Am J Cancer 1932; 16:1358–1414.

    Google Scholar 

  7. 7

    Moertel CG, Dockerty MB, Baggenstoss AH. Multiple primary malignant neoplasms. II. Tumors of different tissues or organs. Cancer 1961; 14:231–237.

    CAS  PubMed  Google Scholar 

  8. 8

    Curtis RE, Freedman DM, Ron E, Ries LA, Hacker DG, Edwards BK, et al. New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973 -2000. Bethesda, MD: National Cancer Institute 2006: 9–14.

    Google Scholar 

  9. 9

    Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous- cell carcinoma of the head and neck. N Engl J Med 2004; 350:1937–1944.

    Article  Google Scholar 

  10. 10

    Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004; 350:1945–1952.

    CAS  Article  Google Scholar 

  11. 11

    Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003; 349:2091–2098.

    CAS  Article  Google Scholar 

  12. 12

    Lee N, Chan K, Bekelman JE, Zhung J, Mechalakos J, Narayana A, et al. Salvage re-irradiation for recurrent head and neck cancer. Int J Radiat Oncol Biol Phys 2007; 68:731–740.

    Article  Google Scholar 

  13. 13

    Salama JK, Vokes EE, Chmura SJ, Milano MT, Kao J, Stenson KM, et al. Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2006; 64:382–391.

    Article  Google Scholar 

  14. 14

    Biagioli MC, Harvey M, Roman E, Raez LE, Wolfson AH, Mutyala S, et al. Intensity-modulated radiotherapy with concurrent chemotherapy for previously irradiated, recurrence head and neck cancer. Int J Radiat Oncol Biol Phys 2007; 69:1067–1073.

    Article  Google Scholar 

  15. 15

    Wong SJ, Machtay M, Li Y. Locally recurrent, previously irradiated head and neck cancer: concurrent re-irradiation and chemotherapy, or chemotherapy alone? J Clin Oncol 2006; 24:2653–2658.

    Article  Google Scholar 

  16. 16

    Sulman EP, Schwartz DL, Le TT, et al. IMRT reirradiation of head and neck cancer – disease control and morbidity outcomes. Int J Radiat Oncol Biol Phys 2009; 73:399–409.

    Article  Google Scholar 

  17. 17

    Emami B, Bignardi M, Spector GJ, et al. Reirradiation of recurrent head and neck cancers. Laryngoscope 1987; 97:85–88.

    CAS  Article  Google Scholar 

  18. 18

    Popovtzer A, Gluck I, Chepeha DB, et al. The pattern of failure after reirradiation of recurrence squamous cell head and neck cancer: implications for defining the targets. Int J Radiat Oncol Biol Phys 2009; 74:1342–1347.

    Article  Google Scholar 

  19. 19

    Mackie TR, Kapatoes J, Ruchala K, et al. Image guidance for precise conformal radiotherapy. Int J Radiat Oncol Biol Phys 2003; 56:89–105.

    Article  Google Scholar 

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Correspondence to Sweety Gupta MBBS, MD.

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Gupta, S., Gupta, A., Choudhary, P. et al. Feasibility of reirradiation and treatment outcome in a previously irradiated territory in head-and-neck malignancies. Egypt J Otolaryngol 34, 283–288 (2018). https://doi.org/10.4103/ejo.ejo_56_18

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Keywords

  • image-guided intensity-modulated radiotherapy
  • reirradiation
  • second malignancy
  • surgery