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Hirose K, Sato M. Clinical Results and Prognostic Factors in Boron Neutron Capture Therapy for Recurrent Squamous Cell Carcinoma of the Head and Neck Under the Japan National Health Insurance System: A Retrospective Study of the Initial 47 Patients. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00466-8. [PMID: 38580084 DOI: 10.1016/j.ijrobp.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/13/2024] [Accepted: 03/26/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE Recurrent head and neck cancer presents a therapeutic challenge because of cumulative toxicity from initial radiation therapy, limiting reirradiation options. Boron neutron capture therapy (BNCT) offers a promising alternative, selectively delivering a radical dose to tumors while sparing adjacent normal tissue. This study investigates the initial clinical outcomes and prognostic factors associated with BNCT for recurrent squamous cell carcinoma of the head and neck. METHODS AND MATERIALS This retrospective analysis investigated the initial 47 patients treated with BNCT between May 2020 and February 2021 in Japan. All patients had received radiation therapy with a median dose of 70 Gy (range, 44-176) before BNCT. Median tumor size was 11 cm3 (range, 1-117 cm3), with 23% of tumors larger than 30 cm3, and 87% of patients had prior systemic therapy. The most common prescribed dose to the pharyngeal mucosa was 15 Gy-Eq (36%), followed by 18 Gy-Eq (34%). The minimum dose given to tumor was 27.4 Gy-Eq (range, 13.3-45.2). In 23 patients, 18F-fluoro-borono-phenylalanine positron emission tomography was performed within 1 week before BNCT, and the tumor-to-blood 10B ratio was 3.5 (range, 2.0-8.7). RESULTS Efficacy analysis revealed a 51% complete response rate and a 74% overall response rate. Disease-free survival rates at 1 and 2 years were 34.6% and 26.6%, respectively. Overall survival rates at 1 and 2 years were 86.1% and 66.5%, respectively. Multivariate analysis revealed that, among the patient characteristics, whether the lesion was mucosal had a significant effect on achieving complete response. CONCLUSIONS This study provided valuable insights into the early integration of BNCT into routine clinical practice, highlighting its efficacy and safety. Technical improvements are needed to ensure precise dose administration. Ongoing prospective studies, such as the phase II REBIVAL study, will further elucidate the role of BNCT in recurrent head and neck cancer.
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Affiliation(s)
- Katsumi Hirose
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, Koriyama, Fukushima, Japan; Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
| | - Mariko Sato
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, Koriyama, Fukushima, Japan; Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Sato M, Hirose K, Takeno S, Aihara T, Nihei K, Takai Y, Hayashi T, Bando K, Kimura H, Tsurumi K, Ono K. Safety of Boron Neutron Capture Therapy with Borofalan( 10B) and Its Efficacy on Recurrent Head and Neck Cancer: Real-World Outcomes from Nationwide Post-Marketing Surveillance. Cancers (Basel) 2024; 16:869. [PMID: 38473231 DOI: 10.3390/cancers16050869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND This study was conducted to evaluate the real-world safety and efficacy of boron neutron capture therapy (BNCT) with borofalan(10B) in Japanese patients with locally advanced or locally recurrent head and neck cancer (LA/LR-HNC). METHODS This prospective, multicenter observational study was initiated in Japan in May 2020 and enrolled all patients who received borofalan(10B) as directed by regulatory authorities. Patient enrollment continued until at least 150 patients were enrolled, and adverse events attributable to drugs, treatment devices, and BNCT were evaluated. The patients with LA/LR-HNC were systematically evaluated to determine efficacy. RESULTS The 162 patients enrolled included 144 patients with squamous cell carcinoma of the head and neck (SCCHN), 17 patients with non-SCCHN (NSCCHN), and one patient with glioblastoma. Treatment-related adverse events (TRAEs) were hyperamylasemia (84.0%), stomatitis (51.2%), sialoadenitis (50.6%), and alopecia (49.4%) as acute TRAEs, and dysphagia (4.5%), thirst (2.6%), and skin disorder (1.9%) as more common late TRAEs. In patients with LA/LR-HNC, the overall response rate (ORR) was 72.3%, with a complete response (CR) in 63 (46.0%) of 137 patients with SCCHN. Among 17 NSCCHN patients, the ORR was 64.7%, with eight cases (47.1%) of CR. One- and two-year OS rates in patients with recurrent SCCHN were 78.8% and 60.7%, respectively. CONCLUSIONS This post-marketing surveillance confirmed the safety and efficacy of BNCT with borofalan(10B) in patients with LA/LR-HNC in a real-world setting.
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Affiliation(s)
- Mariko Sato
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10 Yatsuyamada, Koriyama 963-8052, Japan
| | - Katsumi Hirose
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10 Yatsuyamada, Koriyama 963-8052, Japan
| | - Satoshi Takeno
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Teruhito Aihara
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
- Department of Otolaryngology Head and Neck Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Keiji Nihei
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Yoshihiro Takai
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10 Yatsuyamada, Koriyama 963-8052, Japan
| | - Toshimitsu Hayashi
- Stella Pharma Corporation, ORIX Kouraibashi Building, 3-2-7 Kouraibashi, Chuo-ku, Osaka 541-0043, Japan
| | - Kosuke Bando
- Stella Pharma Corporation, ORIX Kouraibashi Building, 3-2-7 Kouraibashi, Chuo-ku, Osaka 541-0043, Japan
| | - Hitomi Kimura
- Stella Pharma Corporation, ORIX Kouraibashi Building, 3-2-7 Kouraibashi, Chuo-ku, Osaka 541-0043, Japan
| | - Keisuke Tsurumi
- Sumitomo Heavy Industries, Ltd., 5-2 Soubirakichou, Niihama 792-0001, Japan
| | - Koji Ono
- BNCT Joint Clinical Institute, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
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Scolari C, Buchali A, Franzen A, Förster R, Windisch P, Bodis S, Zwahlen DR, Schröder C. Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database. Front Oncol 2023; 13:1175609. [PMID: 37456239 PMCID: PMC10346436 DOI: 10.3389/fonc.2023.1175609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Re-irradiation (re-RT) in head and neck cancer is challenging. This study prospectively explored the feasibility of re-RT in patients with loco-regionally recurrent or second primary head and neck cancer (LRR/SP HNC). Methods From 2004 to 2021, 61 LRR/SP HNC patients were treated with re-RT, defined as having a second course of RT with curative intent resulting in a cumulative dose of ≥100 Gy in an overlapping volume. Postoperative or definitive dynamic intensity-modulated and/or volumetric modulated re-RT was administered using twice daily hyperfractionation to 60 Gy combined with cisplatin or carboplatin/5-fluorouracil. Overall survival (OS), progression-free survival (PFS), locoregional control (LRC) and distant metastasis control (DMC) were analyzed and prognostic factors evaluated. Toxicity was prospectively recorded and graded. Results The median follow-up was 9.8 months. In 41 patients (67.1%), complete administration of the intended treatment was not feasible. In 9 patients (15%) re-RT was interrupted prematurely and in other 9, the complete re-RT dose was lower than 60 Gy, and 37 patients (61%) could not receive or complete chemotherapy. Two-year OS, PFS and LRC rates were 19%, 18% and 30%, respectively. 20 patients (33%) received the complete intended treatment, and 1- and 2-year OS rates were 70% and 47%, respectively. Charlson comorbidity index was an important predictor for treatment completion. Multivariate analysis revealed recurrent N stage 0-1, age, chemotherapy administration and re-RT dose of 60 Gy as prognostic factors for clinical outcomes. No grade 5 re-RT-related toxicity was observed. The most common new grade ≥3 acute toxicities were dysphagia (52%) and mucositis (46%). Late toxicity included grade ≥3 dysphagia in 5% and osteoradionecrosis in 10% of evaluable patients, respectively. 6 patients (10%) were alive after 9 years without progression and no late toxicity grade ≥3, except for 2 patients presenting with osteoradionecrosis. Conclusion Hyperfractionated re-RT with 60 Gy combined with platinum-based chemotherapy was a curative treatment option with acceptable toxicity in LRR/SP patients. Patients with higher comorbidity had a higher probability of failing to receive and complete the intended therapy. Consequently, they derived unsatisfactory benefits from re-RT, highlighting the importance of patient selection.
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Affiliation(s)
- Chiara Scolari
- Department of Radiation Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - André Buchali
- Department of Radiation Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
| | - Achim Franzen
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg university of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Paul Windisch
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Stephan Bodis
- Center for Radiation Oncology, Cantonal Hospital Aarau and Baden (KSA-KSB), Aarau/Baden, Switzerland
| | - Daniel R. Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
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Mohamad I, Abu Hejleh T, Abdelqader S, Wahbeh L, Taqash A, Almousa A, Mayta E, Al-Ibraheem A, Abuhijla F, Abu-Hijlih R, Hussein T, Al-Gargaz W, Ghatasheh H, Hosni A. Re-Irradiation for Recurrent Head and Neck Cancer: Freedom from Cancer Recurrence Rate. J Clin Med 2023; 12:jcm12082979. [PMID: 37109315 PMCID: PMC10145776 DOI: 10.3390/jcm12082979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Salvage re-irradiation (rRT) for patients with locoregionally recurrent head and neck cancer (rHNC) remains challenging. A retrospective analysis was performed on 49 patients who received rRT between 2011 and 2018. The co-primary endpoint of the study was 2-year freedom from cancer recurrence rate (FCRR) and overall survival (OS), and secondary endpoints were 2-year disease-free survival (DFS), local failure (LF), regional failure (RF), distant metastases (DM), and RTOG grade 3 ≥ late toxicities. Adjuvant and definitive rRT were delivered to 22 and 27 patients, respectively. A total of 91% of patients were managed with conventional re-RT and 71% of patients received concurrent chemotherapy. The median follow-up after rRT was 30 months. The 2-year FCRR, OS, DFS, LF, RF, and DM were 64%, 51%, 28%, 32%, 9%, and 39% respectively. MVA showed that poor performance status (PS: 1-2 vs. 0) and age > 52 years were predictive of worse OS. In comparison, poor PS (1-2 vs. 0) and total dose of rRT < 60 Gy were predictive of worse DFS. Late RTOG toxicity of grade 3 ≥ was reported in nine (18.3%) patients. FCRR at 2 years after salvage rRT for rHNC was higher than other traditional endpoints and could be an important endpoint to be included in future rRT studies. rRT for rHNC at our cohort was relatively successful, with a manageable level of late severe toxicity. Replacing this approach in other developing countries is a viable option.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Taher Abu Hejleh
- Department of Medical Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Sania Abdelqader
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Lina Wahbeh
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Ayat Taqash
- Department of Biostatistics, King Hussein Cancer Center, Amman 11942, Jordan
| | - Abdelatif Almousa
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Ebrahim Mayta
- Department of Surgical Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman 11942, Jordan
| | - Fawzi Abuhijla
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Ramiz Abu-Hijlih
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Tariq Hussein
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Wisam Al-Gargaz
- Department of Surgical Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Hamza Ghatasheh
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada
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Reirradiation for local recurrence of oral, pharyngeal, and laryngeal cancers: a multi-institutional study. Sci Rep 2023; 13:3062. [PMID: 36810749 PMCID: PMC9944926 DOI: 10.1038/s41598-023-29459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
This study aimed to examine the efficacy and toxicity of reirradiation in patients with locally recurrent oral, pharyngeal, and laryngeal cancers. We conducted a retrospective, multi-institutional analysis of 129 patients with previously irradiated cancer. The most frequent primary sites were the nasopharynx (43.4%), oral cavity (24.8%), and oropharynx (18.6%). With a median follow-up duration of 10.6 months, the median overall survival was 14.4 months and the 2-year overall survival rate was 40.6%. For each primary site, the 2-year overall survival rates were 32.1%, 34.6%, 30%, 60.8%, and 5.7% for the hypopharynx, oral cavity, larynx, nasopharynx, and oropharynx, respectively. Prognostic factors for overall survival were primary site (nasopharynx versus other sites) and gross tumor volume (GTV) (≤ 25 cm3 versus > 25 cm3). The 2-year local control rate was 41.2%. Twenty-four patients (18.6%) presented with grade ≥ 3 toxicities, including nine with hemorrhages that led to grade 5 toxicities in seven patients. All nine tumors that caused hemorrhage showed tumor encasement of the carotid ≥ 180 degrees and eight of nine tumors had larger GTV > 25 cm3. Reirradiation is a feasible treatment option for small local recurrence of oral, pharyngeal, and laryngeal cancers, with the requirement of a strict eligibility assessment for large tumors with carotid encasement.
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6
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Li Y, Jiang Y, Qiu B, Sun H, Wang J. Current radiotherapy for recurrent head and neck cancer in the modern era: a state-of-the-art review. J Transl Med 2022; 20:566. [PMID: 36474246 PMCID: PMC9724430 DOI: 10.1186/s12967-022-03774-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In the management of head and neck cancer (HNC) patients, local recurrence is a common cause of treatment failure. Only a few patients with recurrent HNC (rHNC) are eligible for salvage surgery and the majority of patients receive systemic therapy and radiotherapy. In recent years, with the development of irradiation technology, radiotherapy for rHNC patients has markedly attracted clinicians' attention and its therapeutic effects on patients with end-stage cancer are worthy of investigation as well. METHODS Several studies have investigated the role of radiotherapy in the treatment of rHNC patients. We reviewed retrospective reports and prospective trials published in recent decades that concentrated on the management of rHNC. RESULTS A growing body of evidence supported the application of irradiation to rHNC patients. According to the results of this review, current radiotherapy could achieve a better efficacy with a lower incidence of toxicity. CONCLUSION Radiotherapy is a promising treatment for rHNC patients.
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Affiliation(s)
- Yue Li
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 China
| | - Yuliang Jiang
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 China
| | - Bin Qiu
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 China
| | - Haitao Sun
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 China
| | - Junjie Wang
- grid.411642.40000 0004 0605 3760Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 China
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Beddok A, Saint‐Martin C, Krhili S, Eddine CA, Champion L, Chilles A, Goudjil F, Zefkili S, Amessis M, Peurien D, Choussy O, le Tourneau C, Dendale R, Buvat I, Créhange G, Calugaru V. Curative high‐dose reirradiation for patients with recurrent head and neck squamous cell carcinoma using IMRT or proton therapy: Outcomes and analysis of patterns of failure. Head Neck 2022; 44:2452-2464. [DOI: 10.1002/hed.27153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Arnaud Beddok
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
- PSL Research University, University Paris Saclay, Inserm LITO U1288 Institut Curie Orsay France
| | | | - Samar Krhili
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | | | | | - Anne Chilles
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Farid Goudjil
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Sofia Zefkili
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Malika Amessis
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Dominique Peurien
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Olivier Choussy
- Department of Head and Neck Surgery Institut Curie Paris France
| | - Christophe le Tourneau
- Department of Drug Development and Innovation (D3i), INSERM U900 Research unit Paris‐Saclay University. Institut Curie Paris France
| | - Remi Dendale
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Irene Buvat
- PSL Research University, University Paris Saclay, Inserm LITO U1288 Institut Curie Orsay France
| | - Gilles Créhange
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
| | - Valentin Calugaru
- PSL Research University, Radiation Oncology Department Institut Curie Paris/Orsay France
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Ward MC, Koyfman SA, Bakst RL, Margalit DN, Beadle BM, Beitler JJ, Chang SSW, Cooper JS, Galloway TJ, Ridge JA, Robbins JR, Sacco AG, Tsai CJ, Yom SS, Siddiqui F. Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC): Expert Panel on Radiation Oncology - Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2022; 113:759-786. [PMID: 35398456 DOI: 10.1016/j.ijrobp.2022.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Re-treatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice. METHODS We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method. RESULTS The final number of citations retained for review was 274. These informed five key questions, which focused on patient selection, adjuvant re-irradiation, definitive re-irradiation, stereotactic body radiation (SBRT), and re-irradiation to treat non-squamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence. CONCLUSIONS This provides updated evidence-based recommendations and guidelines for the re-treatment of recurrent or second primary cancer of the head and neck.
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Affiliation(s)
- Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.
| | | | | | - Danielle N Margalit
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Beth M Beadle
- Stanford University School of Medicine, Palo Alto, California
| | | | | | | | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jared R Robbins
- University of Arizona College of Medicine Tucson, Tucson, Arizona
| | - Assuntina G Sacco
- University of California San Diego Moores Cancer Center, La Jolla, California
| | - C Jillian Tsai
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sue S Yom
- University of California, San Francisco, California
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9
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Lee HI, Kim JH, Ahn SH, Chung EJ, Keam B, Eom KY, Jeong WJ, Kim JW, Wee CW, Wu HG. Re-irradiation for recurrent or second primary head and neck cancer. Radiat Oncol J 2022; 39:279-287. [PMID: 34986549 PMCID: PMC8743457 DOI: 10.3857/roj.2021.00640] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/17/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose To investigate the efficacy and safety of intensity-modulated radiotherapy (IMRT)-based re-irradiation (reRT) for recurrent or second primary head and neck cancer (HNC). Materials and Methods Patients who underwent IMRT-based reRT for recurrent or second primary HNC between 2007 and 2019 at two institutions were included. Medical records and dosimetric data were retrospectively reviewed. Overall survival (OS), progression-free survival (PFS), severe late toxicities, and clinicopathological prognostic factors were analyzed. Results A total of 42 patients were analyzed. With a median follow-up of 15.1 months (range, 3.7 to 85.8 months), the median OS was 28.9 months with a 2-year OS rate of 54.6%. The median PFS and 2-year PFS rates were 10.0 months and 30.9%, respectively. Multivariate analysis showed that good performance (Eastern Cooperative Oncology Group [ECOG] 0 or 1), a longer time interval (≥24 months) between radiotherapy courses, and higher reRT dose (>60 Gy) were significantly favorable factors for OS (all p < 0.05). Higher reRT dose and salvage surgery were significantly associated with improved PFS (all p < 0.05). Regarding the Multi‐Institution Reirradiation (MIRI) Collaborative RPA classification, the 2-year OS rates of each class were 87.5% in class I, 51.8% in class II, and 0% in class III (p = 0.008). Grade ≥3 late toxicity was reported in 10 (23.8%) patients. There was no significant factor associated with increased late toxicities. Conclusion IMRT-based reRT should be considered as a treatment option for patients with recurrent or second primary HNC. Further trials are needed to establish a subset of patients who may benefit from reRT without severe late toxicity.
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Affiliation(s)
- Hye In Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji-Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chan Woo Wee
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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10
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MacFarlane AW, Yeung HM, Alpaugh RK, Dulaimi E, Engstrom PF, Dasari A, Campbell KS, Vijayvergia N. Impacts of pembrolizumab therapy on immune phenotype in patients with high-grade neuroendocrine neoplasms. Cancer Immunol Immunother 2021; 70:1893-1906. [PMID: 33398390 PMCID: PMC8195815 DOI: 10.1007/s00262-020-02811-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023]
Abstract
High grade neuroendocrine neoplasms (G3 NENs) are rare aggressive tumors with limited treatment options. Twenty-one previously treated patients with metastatic extra-pulmonary G3 NENs were treated with pembrolizumab. Baseline tumor samples were assessed for PD-L1 and tumor infiltrating lymphocytes (TIL). Peripheral blood samples drawn pre-treatment, prior to cycle three, and at disease progression were analyzed by flow cytometry. One patient achieved partial response, two had stable disease, and 18 exhibited progressive disease. The partially responding patient did not progress after 392 days, and the median progression-free survival (PFS) was 59 days. Longer PFS correlated independently with higher pre-treatment peripheral blood T-cell counts and lower pre-treatment activation state (CD69 expression) of naïve T cells and NK cells. Peripheral T-cell viability was reduced in patients with greater TILs. Post-treatment, T cells had reduced numbers of CD4+ cells, reduced PD-1 expression, increased activation of effector (CD62L-) cells, and increased expression of TIGIT. Baseline TIGIT expression on peripheral T cells also correlated positively with Ki67 in tumor. Patients with higher baseline T-cell expression of TIM-3 had shorter PFS. Despite limited activity of pembrolizumab, this study highlights the immune phenotype in this rare tumor type before and after treatment. High baseline peripheral T-cell count and reduced activation of T and NK cell subsets were associated with improved outcomes. Furthermore, increased post-treatment TIGIT and elevated baseline TIM-3 expression suggest that these may limit the efficacy of pembrolizumab, providing a rationale for combination immunotherapy (PD-1 with TIGIT and/or TIM-3 antibodies) to treat extra-pulmonary G3 NENs.
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Affiliation(s)
- Alexander W MacFarlane
- Blood Cell Development and Function Program, Institute for Cancer Research, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Ho-Man Yeung
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - R Katherine Alpaugh
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Essel Dulaimi
- Department of Pathology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Paul F Engstrom
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Kerry S Campbell
- Blood Cell Development and Function Program, Institute for Cancer Research, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | - Namrata Vijayvergia
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
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11
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Jiang Y, Zhen P, Dai J, Li Y, Liu S, Xu J, Wang Y, Tian S, Cui Y, Ji Z, Guo F, Qiu B, Sun H, Fan J, Wang J. Long-Term Safety and Efficacy of CT-Guided I 125 Radioactive Seed Implantation as a Salvage Therapy for Recurrent Head and Neck Squamous Carcinoma: A Multicenter Retrospective Study. Front Oncol 2021; 11:645077. [PMID: 34277401 PMCID: PMC8281320 DOI: 10.3389/fonc.2021.645077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the safety and efficacy of CT-guided I125 radioactive seed implantation (RSI) as a salvage therapy for recurrent head and neck squamous carcinoma (rHNSC) after external beam radiotherapy (EBRT) or surgery. Materials and Methods This is a multicenter retrospective study of 113 patients (83 males; median age 57 years) with rHNSC who underwent CT-guided I125 RSI between February 2003 and December 2017. Of the included patients, 107 patients previously received EBRT and 65 patients received surgery and all were ineligible or rejected for salvage surgery and/or repeat EBRT. Results During a median follow-up duration of 20 months (range, 3-152 months), 87 patients died. The 1-, 2-, 3-, and 5-year local control rate were 57.4%, 41.8%, 29.3%, and 15.2%, respectively. The median time to progression was 15 months [95% confidence interval (CI), 6.1-23.9 months]. The median overall survival (OS) was 20 months (95% CI, 12.4-27.6 months). The 1-, 2-, 3-, and 5-year OS rate were 63.6%, 44.6%, 29.9%, and 21.7%, respectively. Univariate and multivariate analyses revealed that KPS score and postoperative D90 were significantly associated with patients’ OS. The complications were mainly grade I/II skin and mucosal reactions: 18 cases (15.9%) of grade I/II and eight cases (7.0%) of grade III radiation dermatitis, and 14 cases (12.4%) of grade I/II and three cases (2.7%) grade III mucosal reactions. No grade IV or severer complications were found. Conclusion CT-guided I125 RSI may be safe as a salvage therapy for rHNSC after EBRT/surgery, yielding promising efficacy compared with historical data. KPS score and postoperative D90 may be significantly associated with OS.
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Affiliation(s)
- Yuliang Jiang
- Department of Radiation Oncology, Peking University 3rdHospital, Beijing, China
| | - Peng Zhen
- Department of Radiation Oncology, Chifeng Cancer Hospital, Chifeng, China
| | - Jinchao Dai
- Department of Nuclear Medicine, Qingdao Central Hospital, Qingdao, China
| | - Yixing Li
- Department of Nuclear Medicine, Yichang First People's Hospital, Yichang, China
| | - Shifeng Liu
- Department of Interventional Radiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Junma Xu
- Department of Respiratory, Jintan District People's Hospital, Changzhou, China
| | - Yufeng Wang
- Department of Nuclear Medicine, Xuzhou Cancer Hospital, Xuzhou, China
| | - Suqing Tian
- Department of Radiation Oncology, Peking University 3rdHospital, Beijing, China
| | - Yue Cui
- Department of Radiation Oncology, Peking University 3rdHospital, Beijing, China
| | - Zhe Ji
- Department of Radiation Oncology, Peking University 3rdHospital, Beijing, China
| | - Fuxin Guo
- Department of Radiation Oncology, Peking University 3rdHospital, Beijing, China
| | - Bin Qiu
- Department of Radiation Oncology, Peking University 3rdHospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University 3rdHospital, Beijing, China
| | - Jinghong Fan
- Department of Radiation Oncology, Peking University 3rdHospital, Beijing, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University 3rdHospital, Beijing, China
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12
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Kharouta M, Zender C, Podder T, Rezaee R, Lavertu P, Fowler N, Thuener J, Li S, Clancy K, Xu Z, Yao M. Permanent Interstitial Cesium-131 Brachytherapy in Treating High-Risk Recurrent Head and Neck Cancer: A Prospective Pilot Study. Front Oncol 2021; 11:639480. [PMID: 33816283 PMCID: PMC8012839 DOI: 10.3389/fonc.2021.639480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose/Objectives To establish the feasibility and safety of intraoperative placement of cesium-131 (Cs-131) seeds for re-irradiation in recurrent head and neck cancer (HNC). Methods Patients with resectable recurrent HNC who were deemed to have a high risk of second recurrence were eligible. Immediately after tumor extirpation, seeds were implanted in the surgical bed based on the preoperative treatment plan with intraoperative adjustment. The surgical bed and the seeds were covered with a regional flap or microvascular free flap. A CT of the neck was obtained on postoperative day 1 for evaluation of the postoperative dose distribution. Patients were followed 1 and 3 months after surgery, then every 3 months in the first 2 years. Results From November 2016 to September 2018, 15 patients were recruited and 12 patients received treatment per protocol. For the patients who had implants, the sites of initial recurrence included 10 neck alone, 1 neck and larynx, and 1 neck/peristomal. The median follow-up was 21.4 months. After surgery, patients remained hospitalized for a median of 6 days. There were no high-grade toxicities except two patients with wound complications requiring wound care. Eight patients had recurrences, three locoregional alone, three distant alone, and two with both locoregional and distant recurrences. Only one patient had an in-field failure. Five patients died, with 1- and 2-year overall survival of 75 and 58%. Conclusions Cs-131 implant after surgical resection in recurrent HNC is feasible and safe. There were no unexpected severe toxicities. Most failures were out-of-field or distant. Clinical Trial Registration ClinicalTrials.gov, identifier NCT02794675.
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Affiliation(s)
- Michael Kharouta
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Chad Zender
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Tarun Podder
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Rod Rezaee
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Pierre Lavertu
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Nicole Fowler
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Jason Thuener
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Shawn Li
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Kate Clancy
- Department of Otolaryngology Head and Neck Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Zhengzheng Xu
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Min Yao
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, United States
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13
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Locatello LG, Bruno C, Gallo O. Early glottic cancer recurrence: A critical review on its current management. Crit Rev Oncol Hematol 2021; 160:103298. [PMID: 33716199 DOI: 10.1016/j.critrevonc.2021.103298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Recurrent early glottic cancer (rEGC) poses several issues in terms of timely diagnosis, correct re-staging, and treatment. We want to critically review the latest evidence about rEGC considering its epidemiology, biology, diagnostic challenges, and treatment strategies. METHODS A systematic search of the literature using PubMed from 1990 to October 31, 2020 was performed. RESULTS There are many different treatment options available (open surgery, transoral mini-invasive surgery, radiotherapy), and many factors related to the patient's status and previous treatments must be considered when planning the best management strategy for rEGC. While its overall prognosis remains satisfactory, it is of the utmost importance to appreciate all the clinical implications derived from the choice of the initial therapeutic modality, and from a correct primary and recurrent staging. CONCLUSION The balance between oncological and voice and swallowing functions represents the fundamental principle underlying rEGC management. Future studies should focus on molecular profiling of rEGC, and on the results of the emerging radiation delivery techniques and mini-invasive procedures.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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14
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Hirose K, Konno A, Hiratsuka J, Yoshimoto S, Kato T, Ono K, Otsuki N, Hatazawa J, Tanaka H, Takayama K, Wada H, Suzuki M, Sato M, Yamaguchi H, Seto I, Ueki Y, Iketani S, Imai S, Nakamura T, Ono T, Endo H, Azami Y, Kikuchi Y, Murakami M, Takai Y. Boron neutron capture therapy using cyclotron-based epithermal neutron source and borofalan ( 10B) for recurrent or locally advanced head and neck cancer (JHN002): An open-label phase II trial. Radiother Oncol 2020; 155:182-187. [PMID: 33186684 DOI: 10.1016/j.radonc.2020.11.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE Boron neutron capture therapy (BNCT) can be performed without reactors due to development of cyclotron-based epithermal neutron source (C-BENS), which is optimized for treatment for deeper-seated tumors. The purpose of this study was to evaluate efficacy and safety of cyclotron-based BNCT with borofalan (10B) for recurrent or locally advanced head and neck cancer. MATERIALS AND METHODS In this open-label, phase II JHN002 trial of BNCT using C-BENS with borofalan (10B), patients with recurrent squamous cell carcinoma (R-SCC) or with recurrent/locally advanced non-squamous cell carcinoma (R/LA-nSCC) of the head and neck were intravenously administered 400 mg/kg borofalan (10B), followed by neutron irradiation. The tumor dose was determined passively as the mucosal maximum dose of 12 Gy-Eq. The primary endpoint was the objective response rate (ORR). Post-trial observational JHN002 Look Up study was planned for evaluating locoregional progression-free survival (LRPFS). RESULTS Eight R-SCC and 13 R/LA-nSCC patients were enrolled. All R-SCC patients had prior radiotherapy with a median dose of 65.5 Gy (range, 59.4-76.0 Gy). The ORR for all patients was 71%, and complete response/partial response were 50%/25% in R-SCC and 8%/62% in R/LA-nSCC. The 2-year overall survival for R-SCC and R/LA-nSCC were 58% and 100%, respectively. The median LRPFS was 11.5 months for R-SCC. Frequently observed adverse events included alopecia (95%), hyperamylasemia (86%), and nausea (81%). CONCLUSION These data suggest that BNCT using C-BENS with borofalan (10B) is a promising treatment option for patients with R-SCC or R/LA-nSCC of the head and neck.
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Affiliation(s)
- Katsumi Hirose
- Southern Tohoku BNCT Research Center, Koriyama, Japan; Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, Japan.
| | - Akiyoshi Konno
- Department of Otorhinolaryngology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Junichi Hiratsuka
- Department of Radiation Oncology, Kawasaki Medical School, Kurashiki, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Kato
- Southern Tohoku BNCT Research Center, Koriyama, Japan; Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan; Preparing Section for New Faculty of Medical Science, Fukushima Medical University, Japan
| | - Koji Ono
- Kansai BNCT Medical Center, Osaka Medical College, Japan
| | - Naoki Otsuki
- Department of Otolaryngology, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Japan
| | - Hiroki Tanaka
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, Kumatori, Japan
| | - Kanako Takayama
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Mariko Sato
- Southern Tohoku BNCT Research Center, Koriyama, Japan; Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, Japan
| | - Hisashi Yamaguchi
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Ichiro Seto
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yuji Ueki
- Department of Otorhinolaryngology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Susumu Iketani
- Department of Oral and Maxillofacial Surgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Shigeki Imai
- Department of Radiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Takashi Ono
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Hiromasa Endo
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan; Department of Medical Oncology, School of Medicine, Fukushima Medical University, Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yoshihiro Takai
- Southern Tohoku BNCT Research Center, Koriyama, Japan; Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan
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15
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Lee J, Shin IS, Kim WC, Yoon WS, Koom WS, Rim CH. Reirradiation with intensity-modulated radiation therapy for recurrent or secondary head and neck cancer: Meta-analysis and systematic review. Head Neck 2020; 42:2473-2485. [PMID: 32437021 DOI: 10.1002/hed.26264] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/14/2020] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To summarize outcomes of reirradiation with intensity-modulated radiotherapy (IMRT) for recurrent or secondary head and neck cancer (HNC). METHODS Primary endpoints were 2-year local control (LC) and overall survival (OS). Studies involving only recurrent nasopharyngeal patients with cancer were excluded. RESULTS A total of 17 studies involving 1635 patients were included. Fourteen (82%) of those were retrospective, and 15 (88%) were from single institution. Reirradiation with IMRT produced pooled 2-year LC and OS rates of 52% (95% confidence interval [CI], 46%-57%) and 46% (95% CI, 41%-50%), respectively. In subgroup analyses, the rate of salvage surgery (<42% vs ≥42%) influenced the pooled 2-year LC rate (45.9% vs 58.5%, P = .011). The pooled rates of late grade ≥ 3 and grade 5 toxicities were 26% (95% CI, 20%-32%) and 3.1% (95% CI, 2%-5%), respectively. CONCLUSIONS Reirradiation with IMRT was an effective modality compared to historical outcomes in the pre-IMRT era.
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Affiliation(s)
- Jeongshim Lee
- Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea.,Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - In-Soo Shin
- Graduate School of Education, Dongguk University, Seoul, South Korea
| | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, South Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, South Korea
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16
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Orlandi E, Bonomo P, Ferella L, D'Angelo E, Maddalo M, Alterio D, Infante G, Bacigalupo A, Argenone A, Iacovelli NA, Desideri I, Meduri B, Triggiani L, Volpe S, Belgioia L, Dionisi F, Romanello DA, Fallai C, Miceli R. Long-term outcome of re-irradiation for recurrent or second primary head and neck cancer: A multi-institutional study of AIRO-Head and Neck working group. Head Neck 2019; 41:3684-3692. [PMID: 31355972 DOI: 10.1002/hed.25890] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To report the long-term outcome of patients undergoing re-irradiation (re-RT) for a recurrent or second primary head and neck cancer (RSPHNCs) in seven Italian tertiary centers, while testing the Multi-Institution Reirradation (MIRI) recursive partitioning analysis (RPA) recently published. METHODS We retrospectively analyzed 159 patients. Prognostic factors for overall survival (OS) selected by a random forest model were included in a multivariable Cox analysis. To externally validate MIRI RPA, we estimated the Kaplan-Meier group-stratified OS curves for the whole population. RESULTS Five-year OS was 43.5% (median follow-up: 49.9 months). Nasopharyngeal site, no organ dysfunction, and re-RT volume <36 cm3 were independent factors for better OS. By applying the MIRI RPA to our cohort, a Harrell C-Index of 0.526 was found indicating poor discriminative ability. CONCLUSION Our data reinforce the survival benefit of Re-RT for selected patients with RSPHNC. MIRI RPA was not validated in our population.
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Affiliation(s)
- Ester Orlandi
- Radiotherapy 1 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Letizia Ferella
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa D'Angelo
- Radiation Oncology Department, University Hospital of Modena, Modena, Italy
| | - Marta Maddalo
- Radiation Oncology Department, ASST Spedali Civili di Brescia-Brescia University, Brescia, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriele Infante
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Angela Argenone
- Radiation Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori-Fondazione "GPascale", Naples, Italy
| | | | - Isacco Desideri
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Bruno Meduri
- Radiation Oncology Department, University Hospital of Modena, Modena, Italy
| | - Luca Triggiani
- Radiation Oncology Department, ASST Spedali Civili di Brescia-Brescia University, Brescia, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Liliana Belgioia
- Radiation Oncology Department, San Martino Hospital, Genoa, Italy
- Health Science Department (DISSAL), University of Genoa, San Martino Hospital, Genoa, Italy
| | | | - Domenico Attilio Romanello
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- School of Medicine, University of Milan-Bicocca, Milan, Italy
| | - Carlo Fallai
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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17
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von der Grün J, Köhn J, Loutfi-Krauss B, Blanck O, Rödel C, Balermpas P. Second infield re-irradiation with a resulting cumulative equivalent dose (EQD2 max ) of >180 Gy for patients with recurrent head and neck cancer. Head Neck 2018; 41:E48-E54. [PMID: 30521102 DOI: 10.1002/hed.25428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/23/2018] [Accepted: 09/21/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND For locally recurrent head and neck cancer, re-irradiation with modern techniques like stereotactic body radiotherapy is a promising, possibly curative alternative to palliative systemic therapy. METHODS We report on 1 patient with nasopharyngeal carcinoma (NPC) and 1 patient with cutaneous squamous cell carcinoma (SCC). Both patients received full dose primary treatment (>66 Gy, EQD2), full dose re-irradiation (>50 Gy, EQD2), and a second course of re-irradiation via robotic radiosurgery (CyberKnife) for a second local recurrence. RESULTS Both treatments resulted in adequate tumor response. No grade III-IV acute or late toxicities occurred. Follow-up at 6 months after third irradiation showed partial remission for the patient with NPC. In the second case (SCC), no toxicities occurred and the tumor was in remission 18 months after last treatment. CONCLUSION These cases show that a second course of re-irradiation utilizing modern techniques like robotic radiosurgery might be feasible for carefully selected patients with head and neck cancer.
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Affiliation(s)
- Jens von der Grün
- Department of Radiation Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Janett Köhn
- Department of Radiation Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Britta Loutfi-Krauss
- Department of Radiation Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany.,Saphir Radiosurgery Center, Frankfurt, Germany
| | - Oliver Blanck
- Saphir Radiosurgery Center, Frankfurt, Germany.,Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Claus Rödel
- Department of Radiation Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK) Partner Site Frankfurt am Main, Germany
| | - Panagiotis Balermpas
- Department of Radiation Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany.,Saphir Radiosurgery Center, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK) Partner Site Frankfurt am Main, Germany
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