Maastricht University Medical Center, Department of Radiation Oncology (MAASTRO clinic), GROW School for Oncology and Developmental Biology, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands.
Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):e111-8. doi: 10.1016/j.ijrobp.2011.01.004. Epub 2011 Feb 28.
To analyze the effectiveness and toxicity of reirradiation (re-RT) for head-and-neck cancer.
A retrospective data analysis was performed of 58 patients who underwent re-RT with curative intent. Re-RT was given as definitive treatment in 53% of patients, whereas salvage surgery preceded reirradiation in 47%. The median cumulative RT dose was 119 Gy (range, 76-140). Concurrent chemotherapy was administered with re-RT (CRT) in 57% of patients. Event-free survival was defined as survival without recurrence and without serious toxicity (≥Grade 3).
Median follow-up was 57 months (range, 9-140). Locoregional (LR) control was 50% at 2 and 5 years. The 2-year and 5-year overall survival (OS) was 42% and 34%. The following factors were associated with improved OS: postoperative re-RT (vs. primary re-RT), treatment with RT only (vs. CRT) and interval >3 years between previous RT and re-RT. For patients treated with postoperative re-RT and definitive re-RT, the 5-year OS was 49% and 20%, respectively. Patients treated with CRT had a 5-year OS of 13%. Serious (late) toxicity ≥Grade 3 was observed in 20 of 47 evaluable patients (43%). Three cases of treatment-related death were recorded. The 2- and 5-year serious toxicity-free interval was 59% and 55%, respectively. Associated with increased risk of serious toxicity were CRT and higher re-RT dose. The event-free survival rates at 2 and 5 years were 34% and 31%, respectively.
Re-RT in head-and-neck cancer is associated with poor survival rates of 13-20% in patients with inoperable disease treated with primary (chemo-) re-RT. For this subgroup, however, no other curative options are available. Long-term disease control and survival can be achieved in patients who receive re-RT as an adjunct to surgical resection. The rates of serious toxicity after re-RT are high, with an incidence of approximately 45% at 5 years. Approximately 1 in 3 patients survived re-RT without recurrence and severe complications.
分析头颈部癌症再放疗（re-RT）的有效性和毒性。
对 58 例接受根治性再放疗的患者进行回顾性数据分析。再放疗作为确定性治疗在 53%的患者中进行，而在 47%的患者中，挽救性手术先于再放疗。中位累积放疗剂量为 119Gy（范围，76-140）。57%的患者接受再放疗同步化疗（CRT）。无复发生存定义为无复发且无严重毒性（≥3 级）的生存。
中位随访时间为 57 个月（范围，9-140）。2 年和 5 年局部区域（LR）控制率分别为 50%。2 年和 5 年总生存率（OS）分别为 42%和 34%。以下因素与改善 OS 相关：术后再放疗（vs. 原发性再放疗）、仅放疗（vs. CRT）治疗和前次放疗与再放疗之间的间隔>3 年。对于接受术后再放疗和确定性再放疗的患者，5 年 OS 分别为 49%和 20%。接受 CRT 治疗的患者 5 年 OS 为 13%。在 47 例可评估患者中，有 20 例（43%）观察到严重（迟发性）毒性≥3 级。记录了 3 例与治疗相关的死亡。2 年和 5 年严重毒性无事件间隔分别为 59%和 55%。CRT 和更高的再放疗剂量与严重毒性风险增加相关。2 年和 5 年无事件生存率分别为 34%和 31%。
对于无法手术的原发性（化疗）再放疗患者，头颈部癌症的再放疗与 13-20%的生存率相关。然而，对于这一分组，没有其他根治性选择。对于接受再放疗作为手术切除辅助治疗的患者，可以实现长期疾病控制和生存。再放疗后的严重毒性发生率较高，5 年时约为 45%。大约每 3 例患者中就有 1 例在接受再放疗后无复发和严重并发症。
