Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-18T08:47:52.700Z Has data issue: false hasContentIssue false
  • English
  • Français

Re-irradiation in head and neck cancers: an Indian tertiary cancer centre experience

Published online by Cambridge University Press:  15 October 2014

S Mallick ,
A K Gandhi ,
N P Joshi ,
S Pandit ,
S Bhasker ,
A Sharma ,
A Thakar  and
B K Mohanti
S Mallick
Affiliation:
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, Delhi, India
A K Gandhi*
Affiliation:
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, Delhi, India
N P Joshi
Affiliation:
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, Delhi, India
S Pandit
Affiliation:
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, Delhi, India
S Bhasker
Affiliation:
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, Delhi, India
A Sharma
Affiliation:
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, Delhi, India
A Thakar
Affiliation:
Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, Delhi, India
B K Mohanti
Affiliation:
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, Delhi, India
*
Address for correspondence: Dr Ajeet Kumar Gandhi, Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India Fax: +91-11-26589821 E-mail: ajeetgandhi23@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To explore the treatment outcomes of patients treated with re-irradiation for recurrent or second primary head and neck cancer.

Method:

An analysis was performed of 79 head and neck cancer patients who underwent re-irradiation for second primaries or recurrent disease from January 1999 to December 2011.

Results:

Median time from previous radiation to re-irradiation for second primary or recurrence was 53.6 months (range, 2.7–454.7 months). Median age at diagnosis of first primary was 54 years. Median re-irradiation dose was 45 Gy (range, 45–60 Gy). Acute grade 3 or worse toxicity was seen in 30 per cent of patients. Median progression-free survival for recurrent disease was 15.0 months (95 per cent confidence interval, 8.33–21.66). The following factors had a statistically significant, positive impact on progression-free survival: patient age of less than 50 years (median progression-free survival was 29.43, vs 13.9 months for those aged 50 years or older; p = 0.004) and disease-free interval of 2 years or more (median progression-free survival was 51.66, vs 13.9 months for those with less than 2 years disease-free interval).

Conclusion:

Re-irradiation of second primaries or recurrences of head and neck cancers with moderate radiation doses yields acceptable progression-free survival and morbidity rates.

Keywords

Head And Neck NeoplasmsRadiotherapyRetreatment
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 11 , November 2014 , pp. 996 - 1002
Copyright
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. In: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx [14 September 2014]Google Scholar
2Forastiere, AA, Goepfert, H, Maor, M, Pajak, TF, Weber, R, Morrison, W et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091–8Google Scholar
3Schwartz, LH, Ozsahin, M, Zhang, GN, Touboul, E, De Vataire, F, Andolenko, P et al. Synchronous and metachronous head and neck carcinomas. Cancer 1994;74:1933–83.0.CO;2-X>CrossRefGoogle ScholarPubMed
4Goodwin, WJ. Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means? Laryngoscope 2000;110:1–18Google Scholar
5Forastiere, AA, Metch, B, Schuller, DE, Ensley, JF, Hutchins, LF, Triozzi, P et al. Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study. J Clin Oncol 1992;10:1245–51Google Scholar
6Burtness, B, Goldwasser, MA, Flood, W, Mattar, B, Forastiere, AA. Phase III randomized trial of cisplatin plus placebo compared with cisplatin plus cetuximab in metastatic/recurrent head and neck cancer: an Eastern Cooperative Oncology Group study. J Clin Oncol 2005;23:8646–54Google Scholar
7Soulieres, D, Senzer, NN, Vokes, EE, Hidalgo, M, Agarwala, SS, Siu, LL. Multicenter phase II study of erlotinib, an oral epidermal growth factor receptor tyrosine kinase inhibitor, in patients with recurrent or metastatic squamous cell cancer of the head and neck. J Clin Oncol 2004;22:77–85Google Scholar
8Bentzen, JD, Hansen, HS. Phase II analysis of paclitaxel and capecitabine in the treatment of recurrent or disseminated squamous cell carcinoma of the head and neck region. Head Neck 2007;29:47–51CrossRefGoogle ScholarPubMed
9Honk, WK, Bromer, RH, Amato, DA, Shapshay, S, Vincent, M, Vaughan, C et al. Patterns of relapse in locally advanced head and neck cancer patients who achieved complete remission after combined modality treatment. Cancer 1985;56:1242–5Google Scholar
10Kotwall, C, Sako, K, Razack, MS, Rao, U, Bakamjian, V, Shedd, DP. Metastatic patterns in squamous cell cancer of the head and neck. Am J Surg 1987;154:439–42Google Scholar
11Nishijima, W, Takooda, S, Tokita, N, Takayama, S, Sakura, M. Analyses of distant metastases in squamous cell carcinoma of the head and neck lesions above the clavicle at autopsy. Arch Otolaryngol Head Neck Surg 1993;119:65–8CrossRefGoogle ScholarPubMed
12De Crevoisier, R, Bourhis, J, Domenge, C, Wibault, P, Koscienly, S, Lusinchi, A et al. Full-dose re-irradiation for unresectable head and neck carcinoma: experience at the Gustave-Roussy Institute in a series of 169 patients. J Clin Oncol 1998;16:3556–62CrossRefGoogle Scholar
13Takiar, V, Rosenthal, DI, Ang, K, Beadle, BM, Frank, SJ, Fuller, CD et al. Re-irradiation of head-and-neck cancers: an MD Anderson update. Int J Radiat Oncol Biol Phys 2013;87:S465Google Scholar
14Langendijk, JA, Kasperts, N, Leemans, CR, Doornaert, P, Slotman, BJ. A phase II study of primary re-irradiation in squamous cell carcinoma of head and neck. Radiother Oncol 2006;78:306–12CrossRefGoogle ScholarPubMed
15Salama, JK, Vokes, EE, Chmura, SJ, Milano, MT, Kao, J, Stenson, KM et al. Long-term outcome of concurrent chemotherapy and re-irradiation for recurrent and second primary head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2006;64:382–91Google Scholar
16Watkins, JM, Shirai, KS, Wahlquist, AE, Stuart, RK, Chaudhary, UB, Garrett-Mayer, E et al. Toxicity and survival outcomes of hyperfractionated split-course re-irradiation and daily concurrent chemotherapy in locoregionally recurrent, previously irradiated head and neck cancers. Head Neck 2009;31:493–502Google Scholar
17Radiation Therapy Oncology Group: Acute Radiation Morbidity Scoring Criteria. In: http://www.rtog.org/researchassociates/adverseeventreporting/acuteradiationmorbidityscoringcriteria.aspx [14 September 2014]Google Scholar
18Kaplan, EL, Meier, P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–81CrossRefGoogle Scholar
19AJCC Cancer Staging Manual, 6th edn.New York: Springer, 2002Google Scholar
20Lee, N, Chan, K, Bekelman, JE, Zhung, J, Mechalakos, J, Narayana, A et al. Salvage re-irradiation for recurrent head and neck cancer. Int J Radiat Oncol Biol Phys 2007;68:731–40Google Scholar
21Dawson, LA, Myers, LL, Bradford, CR, Chepeha, BD, Hogikyan, DN, Teknos, NT et al. Conformal re-irradiation of recurrent and new primary head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001;50:377–85Google Scholar
22Wang, CC, McIntyre, J. Re-irradiation of laryngeal carcinoma–techniques and results. Int J Radiat Oncol Biol Phys 1993;26:783–5CrossRefGoogle ScholarPubMed
23Chua, DT, Sham, JS, Hung, KN, Leung, LH, Cheng, PW, Kwong, PW. Salvage treatment for persistent and recurrent T1-2 nasopharyngeal carcinoma by stereotactic radiosurgery. Head Neck 2001;23:791–8Google Scholar
24Oksüz, DC, Meral, G, Uzel, O, Cağatay, P, Turkan, S. Re-irradiation for locally recurrent nasopharyngeal carcinoma: treatment results and prognostic factors. Int J Radiat Oncol Biol Phys 2004;60:388–94CrossRefGoogle Scholar
25Balermpas, P, Keller, C, Hambek, M, Wagenblast, J, Seitz, O, Rödel, C et al. Re-irradiation with cetuximab in locoregional recurrent and inoperable squamous cell carcinoma of the head and neck: feasibility and first efficacy results. Int J Radiat Oncol Biol Phys 2012;83:377–83CrossRefGoogle Scholar
26Kharofa, J, Choong, N, Wang, D, Firat, S, Schultz, C, Sadasiwan, C et al. Continuous-course re-irradiation with concurrent carboplatin and paclitaxel for locally recurrent, nonmetastatic squamous cell carcinoma of the head-and-neck. Int J Radiat Oncol Biol Phys 2012;83:690–5Google Scholar
27Goldstein, DP, Karnell, LH, Yao, M, Chamberlin, GP, Nguyen, TX, Funk, GF. Outcomes following re-irradiation of patients with head and neck cancer. Head Neck 2008;30:765–70CrossRefGoogle Scholar
28Sher, DJ, Haddad, RI, Norris, CM Jr, Posner, MR, Wirth, LJ, Goguen, LA et al. Efficacy and toxicity of re-irradiation using intensity-modulated radiotherapy for recurrent or second primary head and neck cancer. Cancer 2010;116:4761–8Google Scholar
29Zwicker, F, Roeder, F, Hauswald, H, Thieke, C, Timke, C, Schlegel, W et al. Re-irradiation with intensity-modulated radiotherapy in recurrent head and neck cancer. Head Neck 2011;33:1695–702Google Scholar
30Duprez, F, Madani, I, Bonte, K, Boterberg, T, Vakaet, L, Derie, C et al. Intensity-modulated radiotherapy for recurrent and second primary head and neck cancer in previously irradiated territory. Radiother Oncol 2009;93:563–9Google Scholar