Schleifenbaum Julia Katharina, Morgenthaler Janis, Sharma Shachi Jenny, Klußmann Jens Peter, Linde Philipp, Wegen Simone, Rosenbrock Johannes, Baues Christian, Fokas Emmanouil, Khor Richard, Ng Sweet Ping, Marnitz Simone, Trommer Maike
Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.
Radiat Oncol. 2025 Jan 2;20(1):1. doi: 10.1186/s13014-024-02570-y.
Locoregional recurrence (LR) is common in locally advanced head and neck cancer (HNSCC), posing challenges for treatment. We analysed outcome parameters and toxicities for patients being treated with radiotherapy (RT) for LR-HNSCC and investigated patient and disease related prognostic factors in this prognostically unfavourable group.
This analysis includes 101 LR-HNSCC patients treated with RT, radio-chemotherapy (RCT) or radio-immunotherapy (RIT) between 2010 and 2018 at a high-volume tertiary centre. Patient characteristics, tumour and treatment details were retrospectively collected. Overall survival (OS), progression-free survival (PFS) and toxicities according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0 were assessed.
62% of patients were radiotherapy-naïve (initial RT group) while 38% were re-irradiated at site of LR (re-RT group). Median OS for initial RT was 24 months, for re-RT 12 months (p < 0.01). In the RCT subgroup, patients with initial RT had significantly longer OS with 35 months compared to re-RT 12 months (p < 0.05). Patients with UICC grade IV tumours and percutaneous endoscopic gastrostomy (PEG) tube had significantly shorter OS in multivariate analysis: initial RT 13 vs. re-RT 32 months and initial RT 12 vs. re-RT 32 months respectively. Salvage surgery before RT at recurrence was a positive prognostic factor for OS (initial RT 35 vs. re-RT 12 months). Other significant factors for longer OS in univariate analysis included low inflammatory status (Glasgow Prognostic Score 0) and radiation doses ≥ 50 Gy. We detected 37 (15%) ≥ CTCAE Grade 3 events for initial RT and 19 (15%) for re-RT patients.
In this analysis, we identified key prognostic factors including PEG tube and inflammation status that could guide treatment decision. Our findings suggest salvage surgery as preferred treatment option with postoperative RT at LR. Adverse events due to re-RT were acceptable. A radiation dose of ≥ 50 Gy should be administered to achieve better outcomes.
局部区域复发（LR）在局部晚期头颈癌（HNSCC）中很常见，给治疗带来挑战。我们分析了接受放疗（RT）治疗的LR-HNSCC患者的结局参数和毒性，并研究了这一预后不良组中患者和疾病相关的预后因素。
本分析纳入了2010年至2018年期间在一家大型三级中心接受RT、放化疗（RCT）或放射免疫治疗（RIT）的101例LR-HNSCC患者。回顾性收集患者特征、肿瘤及治疗细节。根据不良事件通用术语标准（CTCAE）v5.0评估总生存期（OS）、无进展生存期（PFS）和毒性。
62%的患者为初治放疗（初始RT组），38%的患者在LR部位接受再程放疗（再程RT组）。初始RT组的中位OS为24个月，再程RT组为12个月（p＜0.01）。在RCT亚组中，初始RT患者的OS明显更长，为35个月，而再程RT患者为12个月（p＜0.05）。在多因素分析中，国际抗癌联盟（UICC）IV级肿瘤患者和经皮内镜下胃造口术（PEG）置管患者的OS明显更短：初始RT组分别为13个月和再程RT组为32个月，初始RT组为12个月和再程RT组为32个月。复发时RT前的挽救性手术是OS的一个积极预后因素（初始RT组为35个月和再程RT组为12个月）。单因素分析中OS更长的其他显著因素包括低炎症状态（格拉斯哥预后评分0）和放射剂量≥50 Gy。我们在初始RT组中检测到37例（15%）≥CTCAE 3级事件，在再程RT组中检测到19例（15%）。
在本分析中，我们确定了包括PEG置管和炎症状态在内的关键预后因素，这些因素可指导治疗决策。我们的研究结果表明，挽救性手术是LR患者术后RT的首选治疗方案。再程RT引起的不良事件是可接受的。应给予≥50 Gy的放射剂量以获得更好的疗效。
