Bagley Alexander F, Garden Adam S, Reddy Jay P, Moreno Amy C, Frank Steven J, Rosenthal David I, Morrison William H, Gunn Gary Brandon, Fuller Clifton D, Shah Shalin J, Ferrarotto Renata, Sturgis Erich M, Gross Neil D, Phan Jack
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Head Neck. 2020 Nov;42(11):3326-3335. doi: 10.1002/hed.26384. Epub 2020 Aug 9.
Reirradiation of head and neck cancer is associated with high rates of locoregional failure and potentially severe treatment-related toxicity. We report our institutional experience of reirradiation using modern highly conformal radiotherapy approaches in patients with prior oropharyngeal radiation.
We reviewed patients receiving curative-intent reirradiation with intensity-modulated radiation therapy, stereotactic body radiation therapy, and proton beam radiotherapy at our institution from 1999 to 2019. Disease control, survival, and toxicity rates following reirradiation were determined.
Sixty-nine patients were evaluated. Local control (LC), progression-free survival, and overall survival at 2 years following reirradiation were 77%, 35%, and 51%, respectively. Grade 3 or greater (G3+) late toxicities occurred in 46% of patients and 41% required feeding tube placement during or after reirradiation.
In select patients with prior oropharyngeal radiation, highly conformal reirradiation offers acceptable LC, but G3+ toxicity and out-of-field failure rates remain high. These findings warrant continued evaluation of new multimodality approaches to improve oncologic outcomes.
头颈部癌再程放疗与较高的局部区域复发率以及潜在的严重治疗相关毒性有关。我们报告了我院在既往接受口咽放疗的患者中使用现代高剂量适形放疗方法进行再程放疗的经验。
我们回顾了1999年至2019年在我院接受根治性再程放疗的患者，这些患者采用了调强放射治疗、立体定向体部放射治疗和质子束放疗。确定了再程放疗后的疾病控制、生存和毒性发生率。
共评估了69例患者。再程放疗后2年的局部控制率（LC）、无进展生存率和总生存率分别为77%、35%和51%。46%的患者发生3级或更高级别（G3+）晚期毒性反应，41%的患者在再程放疗期间或之后需要放置饲管。
在既往接受口咽放疗的特定患者中，高剂量适形再程放疗可提供可接受的局部控制率，但G3+毒性反应和野外失败率仍然很高。这些发现值得继续评估新的多模式方法以改善肿瘤学结局。
