Hsieh Kristin, Hotca Alexandra Elena, Dickstein Daniel R, Lehrer Eric J, Hsieh Celina, Gupta Vishal, Sindhu Kunal K, Liu Jerry T, Reed Samuel H, Chhabra Arpit, Misiukiewicz Krzysztof, Roof Scott, Kahn Mohemmed Nazir, Kirke Diana, Urken Mark, Posner Marshall, Genden Eric, Bakst Richard L
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Adv Radiat Oncol. 2023 Dec 10;9(4):101418. doi: 10.1016/j.adro.2023.101418. eCollection 2024 Apr.
For patients with head and neck squamous cell carcinoma (HNSCC), locoregional failure and second primary tumors are common indications for adjuvant reirradiation (re-RT). Given an absence of clear consensus on the role of adjuvant re-RT, we sought to assess histopathologic risk factors of patients with HNSCC and their resulting outcomes after adjuvant re-RT with proton therapy.
We conducted a retrospective analysis of patients with HNSCC who underwent salvage surgery at our institution followed by adjuvant re-RT with proton therapy over 1.5 years. All included patients received prior radiation therapy. The Kaplan-Meier method was used to evaluate locoregional recurrence-free survival and overall survival.
The cohort included 22 patients, with disease subsites, including oropharynx, oral cavity, hypopharynx, larynx, and nasopharynx. Depending on adverse pathologic features, adjuvant re-RT to 66 Gy (32% of cohort) or 60 Gy (68%), with (59%) or without (41%) concurrent systemic therapy was administered. The majority (86%) completed re-RT with no reported treatment delay; 3 patients experienced grade ≥3 acute Common Terminology Criteria for Adverse Events toxicity and no patient required enteral feeding tube placement during re-RT. Median follow-up was 21.0 months (IQR, 11.7-25.2 months). Five patients had biopsy-proven disease recurrences a median of 5.9 months (IQR, 3.8-9.7 months) after re-RT. Locoregional recurrence-free survival was 95.2%, 70.2%, 64.8% at 6, 12, and 24 months, respectively. OS was 100%, 79.2%, and 79.2% at 6, 12, and 24 months, respectively. Four patients had osteoradionecrosis on imaging a median of 13.2 months (IQR, 8.7-17.4 months) after re-RT, with 2 requiring surgical intervention.
Adjuvant re-RT for patients with HNSCC was well-tolerated and offered reasonable local control in this high-risk cohort but appears to be associated with a risk of osteoradionecrosis. Additional study and longer follow-up could help define optimal patient management in this patient population.
对于头颈部鳞状细胞癌（HNSCC）患者，局部区域复发和第二原发性肿瘤是辅助性再放疗（re-RT）的常见适应证。鉴于辅助性再放疗的作用尚无明确共识，我们试图评估HNSCC患者的组织病理学危险因素及其在接受质子治疗辅助性再放疗后的结果。
我们对在我院接受挽救性手术并在1.5年内接受质子治疗辅助性再放疗的HNSCC患者进行了回顾性分析。所有纳入患者均接受过先前的放射治疗。采用Kaplan-Meier方法评估局部区域无复发生存率和总生存率。
该队列包括22例患者，疾病亚部位包括口咽、口腔、下咽、喉和鼻咽。根据不良病理特征，给予66 Gy（占队列的32%）或60 Gy（占队列的68%）的辅助性再放疗，同时（占59%）或不（占41%）进行全身治疗。大多数患者（86%）完成了再放疗，未报告治疗延迟；3例患者出现≥3级急性不良事件通用术语标准毒性，再放疗期间无患者需要放置肠内营养管。中位随访时间为21.0个月（四分位间距，11.7 - 25.2个月）。5例患者在再放疗后经活检证实疾病复发，中位时间为5.9个月（四分位间距，3.8 - 9.7个月）。局部区域无复发生存率在6个月、12个月和24个月时分别为95.2%、70.2%和64.8%。总生存率在6个月、12个月和24个月时分别为100%、79.2%和79.2%。4例患者在再放疗后中位13.2个月（四分位间距，8.7 - 17.4个月）的影像学检查中出现放射性骨坏死，其中2例需要手术干预。
HNSCC患者的辅助性再放疗耐受性良好，在这个高危队列中提供了合理的局部控制，但似乎与放射性骨坏死风险相关。进一步的研究和更长时间的随访有助于确定该患者群体的最佳治疗管理方案。
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