Vol 26, No 2 (2021)
Research paper
Published online: 2021-03-04

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Proton re-irradiation of unresectable recurrent head and neck cancers

Konstantin Gordon1, Igor Gulidov2, Alexey Semenov1, Olga Golovanova3, Sergey Koryakin3, Tatyana Makeenkova1, Sergey Ivanov4, Andrey Kaprin5
Rep Pract Oncol Radiother 2021;26(2):203-210.

Abstract

Background: This study presents a retrospective analysis (efficacy and toxicity) of outcomes in patients with unresectable recurrence of previously irradiated head and neck (H&N) cancers treated with proton therapy.

Locoregional recurrence is the main pattern of failure in the treatment of H&N cancers. Proton re-irradiation in patients with relapse after prior radiotherapy might be valid as promising as a challenging treatment option.

Materials and methods: From November 2015 to January 2020, 30 patients with in-field recurrence of head and neck cancer, who were not suitable for surgery due to medical contraindications, tumor localization, or extent, received re-irradiation with intensity-modulated proton therapy (IMPT). Sites of retreatment included the aerodigestive tract (60%) and the base of skull (40%). The median total dose of prior radiotherapy was 55.0 Gy. The median time to the second course was 38 months. The median re-irradiated tumor volume was 158.1 cm3. Patients were treated with 2.0, 2.4, and 3.0 GyRBE per fraction, with a median equivalent dose (EQD2) of 57.6 Gy (a/b = 10). Radiation-induced toxicity was recorded according to the RTOG/EORTC criteria.

Results: The 1- and 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) were 52.6/21.0, 21.9/10.9, and 73.4/8.4%, respectively, with a median follow-up time of 21 months. The median overall survival was 16 months. Acute grade 3 toxicity was observed in one patient (3.3%). There were five late severe side effects (16.6%), with one death associated with re-irradiation.

Conclusion: Re-irradiation with a proton beam can be considered a safe and efficient treatment even for a group of patients with unresectable recurrent H&N cancers. 

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References

  1. Fitzmaurice C, Allen C, Barber RM, et al. Global Burden of Disease Cancer Collaboration. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2017; 3(4): 524–548.
  2. World Health Organization. Head and Neck Cancer: Review of Cancer Medicines on the WHO List of Essential Medicines. WHO, Geneva 2014.
  3. Farrag A, Voordeckers M, Tournel K, et al. Pattern of failure after helical tomotherapy in head and neck cancer. Strahlenther Onkol. 2010; 186(9): 511–516.
  4. Chao KS, Ozyigit G, Tran BN, et al. Determination and delineation of nodal target volumes for head-and-neck cancer based on patterns of failure in patients receiving definitive and postoperative IMRT. Int J Radiat Oncol Biol Phys. 2002; 53(5): 1174–1184.
  5. Bachar GY, Goh C, Goldstein DP, et al. Long-term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy. Eur Arch Otorhinolaryngol. 2010; 267(2): 295–301.
  6. Mabanta SR, Mendenhall WM, Stringer SP, et al. Salvage treatment for neck recurrence after irradiation alone for head and neck squamous cell carcinoma with clinically positive neck nodes. Head Neck. 1999; 21(7): 591–594, doi: 10.1002/(sici)1097-0347(199910)21:7<591::aid-hed1>3.0.co;2-y.
  7. Salama JK, Vokes EE, Chmura SJ, 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(2): 382–391.
  8. Vermorken JB, Mesia R, Rivera F, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008; 359(11): 1116–1127.
  9. Kim YS. Reirradiation of head and neck cancer in the era of intensity-modulated radiotherapy: patient selection, practical aspects, and current evidence. Radiat Oncol J. 2017; 35(1): 1–15.
  10. Spencer SA, Harris J, Wheeler RH, et al. Final report of RTOG 9610, a multi-institutional trial of reirradiation and chemotherapy for unresectable recurrent squamous cell carcinoma of the head and neck. Head Neck. 2008; 30(3): 281–288.
  11. Phan J, Sio TT, Nguyen TP, et al. Reirradiation of Head and Neck Cancers With Proton Therapy: Outcomes and Analyses. Int J Radiat Oncol Biol Phys. 2016; 96(1): 30–41.
  12. Gulidov IA, Mardynsky YuS, Balakin VE, et al. [New opportunities for proton therapy in Russia]. Vopr Onkol. 2016; 62(5): 570–572.
  13. Leonie M, Harald O, Gudrun I. Basics of radiation protection for everyday use: how to achieve ALARA: working tips and guidelines. World Health Organization, Geneva 2004: 83.
  14. Ang KK, Price RE, Stephens LC, et al. The tolerance of primate spinal cord to re-irradiation. Int J Radiat Oncol Biol Phys. 1993; 25(3): 459–464.
  15. Goodwin WJ. Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means? Laryngoscope. 2000; 110(3 Pt 2 Suppl 93): 1–18.
  16. Janot F, de Raucourt D, Benhamou E, et al. Randomized trial of postoperative reirradiation combined with chemotherapy after salvage surgery compared with salvage surgery alone in head and neck carcinoma. J Clin Oncol. 2008; 26(34): 5518–5523.
  17. Pazdur R, Coia R, Hoskins W. Cancer management: A multidisciplinary approach. CMP Healthcare Media, Lawrence 2005: 43–90.
  18. Bachar GY, Goh C, Goldstein DP, et al. Long-term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy. Eur Arch Otorhinolaryngol. 2010; 267(2): 295–301.
  19. Argiris A, Li Yi, Forastiere A. Prognostic factors and long-term survivorship in patients with recurrent or metastatic carcinoma of the head and neck. Cancer. 2004; 101(10): 2222–2229.
  20. Langer CJ, Harris J, Horwitz EM, et al. Phase II study of low-dose paclitaxel and cisplatin in combination with split-course concomitant twice-daily reirradiation in recurrent squamous cell carcinoma of the head and neck: results of Radiation Therapy Oncology Group Protocol 9911. J Clin Oncol. 2007; 25(30): 4800–4805.
  21. Weichselbaum RR, Beckett MA, Schwartz JL, et al. Radioresistant tumor cells are present in head and neck carcinomas that recur after radiotherapy. Int J Radiat Oncol Biol Phys. 1988; 15(3): 575–579.
  22. McDonald MW, Moore MG, Johnstone PAS. Risk of carotid blowout after reirradiation of the head and neck: a systematic review. Int J Radiat Oncol Biol Phys. 2012; 82(3): 1083–1089.
  23. Takiar V, Garden AS, Ma D, et al. Reirradiation of Head and Neck Cancers With Intensity Modulated Radiation Therapy: Outcomes and Analyses. Int J Radiat Oncol Biol Phys. 2016; 95(4): 1117–1131.
  24. Doyen J, Falk AT, Floquet V, et al. Proton beams in cancer treatments: Clinical outcomes and dosimetric comparisons with photon therapy. Cancer Treat Rev. 2016; 43: 104–112.
  25. McDonald MW, Zolali-Meybodi O, Lehnert SJ, et al. Reirradiation of Recurrent and Second Primary Head and Neck Cancer With Proton Therapy. Int J Radiat Oncol Biol Phys. 2016; 96(4): 808–819.
  26. Choe KS, Haraf DJ, Solanki A, et al. Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation. Cancer. 2011; 117(20): 4671–4678.
  27. Lupu-Plesu M, Claren A, Martial S, et al. Effects of proton versus photon irradiation on (lymph)angiogenic, inflammatory, proliferative and anti-tumor immune responses in head and neck squamous cell carcinoma. Oncogenesis. 2017; 6(7): e354.
  28. Chan OSH, Sze HCK, Lee MCH, et al. Reirradiation with intensity-modulated radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma. Head Neck. 2017; 39(3): 533–540.
  29. Cengiz M, Özyiğit G, Yazici G, et al. Salvage reirradiaton with stereotactic body radiotherapy for locally recurrent head-and-neck tumors. Int J Radiat Oncol Biol Phys. 2011; 81(1): 104–109.
  30. Gogineni E, Zhang I, Rana Z, et al. Quality of Life Outcomes Following Organ-Sparing SBRT in Previously Irradiated Recurrent Head and Neck Cancer. Front Oncol. 2019; 9: 836.
  31. Ward MC, Riaz N, Caudell JJ, et al. Multi-Institution Reirradiation (MIRI) Collaborative. Refining Patient Selection for Reirradiation of Head and Neck Squamous Carcinoma in the IMRT Era: A Multi-institution Cohort Study by the MIRI Collaborative. Int J Radiat Oncol Biol Phys. 2018; 100(3): 586–594.



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