Scolari Chiara, Buchali André, Franzen Achim, Förster Robert, Windisch Paul, Bodis Stephan, Zwahlen Daniel R, Schröder Christina
Department of Radiation Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany.
Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland.
Front Oncol. 2023 Jun 29;13:1175609. doi: 10.3389/fonc.2023.1175609. eCollection 2023.
Re-irradiation (re-RT) in head and neck cancer is challenging. This study prospectively explored the feasibility of re-RT in patients with loco-regionally recurrent or second primary head and neck cancer (LRR/SP HNC).
From 2004 to 2021, 61 LRR/SP HNC patients were treated with re-RT, defined as having a second course of RT with curative intent resulting in a cumulative dose of ≥100 Gy in an overlapping volume. Postoperative or definitive dynamic intensity-modulated and/or volumetric modulated re-RT was administered using twice daily hyperfractionation to 60 Gy combined with cisplatin or carboplatin/5-fluorouracil. Overall survival (OS), progression-free survival (PFS), locoregional control (LRC) and distant metastasis control (DMC) were analyzed and prognostic factors evaluated. Toxicity was prospectively recorded and graded.
The median follow-up was 9.8 months. In 41 patients (67.1%), complete administration of the intended treatment was not feasible. In 9 patients (15%) re-RT was interrupted prematurely and in other 9, the complete re-RT dose was lower than 60 Gy, and 37 patients (61%) could not receive or complete chemotherapy. Two-year OS, PFS and LRC rates were 19%, 18% and 30%, respectively. 20 patients (33%) received the complete intended treatment, and 1- and 2-year OS rates were 70% and 47%, respectively. Charlson comorbidity index was an important predictor for treatment completion. Multivariate analysis revealed recurrent N stage 0-1, age, chemotherapy administration and re-RT dose of 60 Gy as prognostic factors for clinical outcomes. No grade 5 re-RT-related toxicity was observed. The most common new grade ≥3 acute toxicities were dysphagia (52%) and mucositis (46%). Late toxicity included grade ≥3 dysphagia in 5% and osteoradionecrosis in 10% of evaluable patients, respectively. 6 patients (10%) were alive after 9 years without progression and no late toxicity grade ≥3, except for 2 patients presenting with osteoradionecrosis.
Hyperfractionated re-RT with 60 Gy combined with platinum-based chemotherapy was a curative treatment option with acceptable toxicity in LRR/SP patients. Patients with higher comorbidity had a higher probability of failing to receive and complete the intended therapy. Consequently, they derived unsatisfactory benefits from re-RT, highlighting the importance of patient selection.
头颈部癌的再程放疗具有挑战性。本研究前瞻性地探讨了局部区域复发或第二原发性头颈部癌（LRR/SP HNC）患者再程放疗的可行性。
2004年至2021年，61例LRR/SP HNC患者接受了再程放疗，定义为进行第二疗程的根治性放疗，在重叠体积中累积剂量≥100 Gy。采用术后或根治性动态调强放疗和/或容积调强再程放疗，每日两次超分割照射至60 Gy，并联合顺铂或卡铂/5-氟尿嘧啶。分析总生存期（OS）、无进展生存期（PFS）、局部区域控制率（LRC）和远处转移控制率（DMC），并评估预后因素。前瞻性记录毒性反应并进行分级。
中位随访时间为9.8个月。41例患者（67.1%）无法完成预期治疗。9例患者（15%）再程放疗提前中断，另外9例患者的再程放疗总剂量低于60 Gy，37例患者（61%）无法接受或完成化疗。两年OS、PFS和LRC率分别为19%、18%和30%。20例患者（33%）完成了预期治疗，1年和2年OS率分别为70%和47%。Charlson合并症指数是治疗完成情况的重要预测因素。多因素分析显示，复发N分期0-1、年龄、化疗使用情况和60 Gy的再程放疗剂量是临床结局的预后因素。未观察到5级再程放疗相关毒性反应。最常见的新出现的≥3级急性毒性反应为吞咽困难（52%）和黏膜炎（46%）。晚期毒性反应包括5%的可评估患者出现≥3级吞咽困难，10%的患者出现骨放射性坏死。6例患者（10%）在9年后存活且无进展，除2例出现骨放射性坏死外，无≥3级晚期毒性反应。
60 Gy超分割再程放疗联合铂类化疗是LRR/SP患者一种毒性可接受的根治性治疗选择。合并症较高的患者接受并完成预期治疗的可能性较低。因此，他们从再程放疗中获得的益处不理想，突出了患者选择的重要性。
