Department of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States.
Department of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, United States.
Radiother Oncol. 2024 Jul;196:110278. doi: 10.1016/j.radonc.2024.110278. Epub 2024 Apr 16.
The optimal management of local-regionally recurrent head and neck cancer that is not amenable to surgical resection is uncertain. We sought to compare outcomes among patients treated with and without re-irradiation in this setting.
A review of institutional registries identified 65 patients with local-regionally recurrent squamous cell carcinoma of the head and neck who were ineligible for surgery. Forty patients (62 %) opted for re-irradiation with the remaining 25 patients (38 %) undergoing initial systemic therapy alone. All patients had measurable disease. Forty-three patients (66 %) were male and twenty-two (33 %) were female. The median age at the time of recurrence was 59 years (range, 39-84 years). The most common primary sites of disease were the oropharynx, (n = 25), oral cavity (N = 19), and nasopharynx (n = 11). The median interval from completion of prior radiation to the diagnosis of recurrent disease was 35 months (range, 2-102 months).
Re-irradiation improved 2-year overall survival, (32 % versus 11 %), progression-free survival (31 % versus 7 %), and local-regional control (39 % versus 3 %) compared to systemic therapy alone (p < 0.05, for both). The likelihood of developing any new grade 3+ toxicity was significantly higher among patients treated by re-irradiation compared to those treated by systemic therapy (53 % vs. 28 %, p < 0.001). There were 3 treatment-related fatalities, all of which occurred in the re-irradiation group. The incidence of grade 3+ late toxicity was 48 % and 12 % for patients in the re-irradiation and systemic therapy cohorts, respectively (p < 0.001).
Although re-irradiation improved overall survival compared to systemic therapy for appropriately selected patients with local-regionally recurrent head and neck cancer, the relatively high risk of toxicity must be considered.
局部区域性复发的头颈部癌症如果不适合手术切除，其最佳治疗方法尚不确定。本研究旨在比较局部区域性复发的头颈部鳞癌患者接受和不接受再放疗的结果。
通过对机构注册数据库的回顾性分析，共确定了 65 例局部区域性复发的头颈部鳞癌患者，这些患者不适合手术。40 例患者（62%）选择再放疗，其余 25 例患者（38%）则单独接受初始系统治疗。所有患者的疾病均为可测量的。43 例患者（66%）为男性，22 例（33%）为女性。复发时的中位年龄为 59 岁（范围：39-84 岁）。最常见的原发部位是口咽（n=25）、口腔（n=19）和鼻咽（n=11）。从上次放疗结束到复发的中位时间间隔为 35 个月（范围：2-102 个月）。
与单独接受系统治疗相比，再放疗可显著提高 2 年总生存率（32%对 11%）、无进展生存率（31%对 7%）和局部区域控制率（39%对 3%）（均为 p<0.05）。与单独接受系统治疗的患者相比，接受再放疗的患者发生任何新的 3 级以上毒性的可能性显著更高（53%对 28%，p<0.001）。再放疗组有 3 例治疗相关死亡，均发生在该组。再放疗组和系统治疗组的 3 级以上迟发性毒性发生率分别为 48%和 12%（p<0.001）。
对于局部区域性复发的头颈部癌症患者，如果选择合适，再放疗可改善总生存率，但毒性风险较高，必须考虑。
