Gordon Konstantin, Gulidov Igor, Semenov Alexey, Golovanova Olga, Koryakin Sergey, Makeenkova Tatyana, Ivanov Sergey, Kaprin Andrey
Department of Proton and Photon Therapy, A. Tsyb Medical Radiological Research Center, Obninsk, Russia.
Radiation Therapy Department, A. Tsyb Medical Radiological Research Center, Obninsk, Russia.
Rep Pract Oncol Radiother. 2021 Apr 14;26(2):203-210. doi: 10.5603/RPOR.a2021.0029. eCollection 2021.
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.
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 cm. Patients were treated with 2.0, 2.4, and 3.0 GyRBE per fraction, with a median equivalent dose (EQD) of 57.6 Gy (α/β = 10). Radiation-induced toxicity was recorded according to the RTOG/EORTC criteria.
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.
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.
本研究对接受质子治疗的既往接受过放疗的头颈部（H&N）癌不可切除复发患者的结局进行了回顾性分析（疗效和毒性）。局部区域复发是头颈部癌治疗失败的主要模式。对于先前放疗后复发的患者，质子再照射作为一种有前景但具有挑战性的治疗选择可能是有效的。
2015年11月至2020年1月，30例因医学禁忌、肿瘤定位或范围而不适合手术的头颈部癌野内复发患者接受了调强质子治疗（IMPT）再照射。再次治疗部位包括气道消化道（60%）和颅底（40%）。先前放疗的中位总剂量为55.0 Gy。第二次疗程的中位时间为38个月。再照射肿瘤体积的中位数为158.1 cm³。患者每次分次接受2.0、2.4和3.0 GyRBE照射，中位等效剂量（EQD）为57.6 Gy（α/β = 10）。根据RTOG/EORTC标准记录放射性毒性。
1年和2年局部控制（LC）、无进展生存期（PFS）和总生存期（OS）分别为52.6%/21.0%、21.9%/10.9%和73.4%/8.4%，中位随访时间为21个月。中位总生存期为16个月。1例患者（3.3%）出现3级急性毒性。有5例晚期严重副作用（16.6%），1例死亡与再照射相关。
即使对于一组不可切除的复发性头颈部癌患者，质子束再照射也可被视为一种安全有效的治疗方法。
