Radiat Oncol J.  2013 Dec;31(4):206-215. 10.3857/roj.2013.31.4.206.

Re-irradiation of unresectable recurrent head and neck cancer: using Helical Tomotherapy as image-guided intensity-modulated radiotherapy

Affiliations
  • 1Department of Radiation Oncology, The Catholic University of Korea College of Medicine, Seoul, Korea. kaycs@catholic.ac.kr
  • 2Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 3Department of Diagnostic Radiology, The Catholic University of Korea College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Re-irradiation (re-RT) is considered a treatment option for inoperable locoregionally recurrent head and neck cancer (HNC) after prior radiotherapy. We evaluated the efficacy and safety of re-RT using Helical Tomotherapy as image-guided intensity-modulated radiotherapy in recurrent HNC.
MATERIALS AND METHODS
Patients diagnosed with recurrent HNC and received re-RT were retrospectively reviewed. Primary endpoint was overall survival (OS) and secondary endpoints were locoregional control and toxicities.
RESULTS
The median follow-up period of total 9 patients was 18.7 months (range, 4.1 to 76 months) and that of 3 alive patients was 49 months (range, 47 to 76 months). Median dose of first radiotherapy and re-RT was 64.8 and 47.5 Gy10. Median cumulative dose of the two courses of radiotherapy was 116.3 Gy10 (range, 91.8 to 128.9 Gy10) while the median interval between the two courses of radiation was 25 months (range, 4 to 137 months). The response rate after re-RT of the evaluated 8 patients was 75% (complete response, 4; partial response, 2). Median locoregional relapse-free survival after re-RT was 11.9 months (range, 3.4 to 75.1 months) and 5 patients eventually presented with treatment failure (in-field failure, 2; in- and out-field failure, 2; out-field failure, 1). Median OS of the 8 patients was 20.3 months (range, 4.1 to 75.1 months). One- and two-year OS rates were 62.5% and 50%, respectively. Grade 3 leucopenia developed in one patient as acute toxicity, and grade 2 osteonecrosis and trismus as chronic toxicity in another patient.
CONCLUSION
Re-RT using Helical Tomotherapy for previously irradiated patients with unresectable locoregionally recurrent HNC may be a feasible treatment option with long-term survival and acceptable toxicities.

Keyword

Recurrent head and neck cancer; Re-RT; Helical Tomotherapy; IG-IMRT; Intensity-modulated radiotherapy; Image-guided radiation therapy

MeSH Terms

Follow-Up Studies
Head and Neck Neoplasms*
Head*
Humans
Osteonecrosis
Radiotherapy
Radiotherapy, Image-Guided
Radiotherapy, Intensity-Modulated*
Retrospective Studies
Treatment Failure
Trismus
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