John A Vargo1, Matthew C Ward2, Jimmy J Caudell3, Nadeem Riaz4, Neal E Dunlap5, Derek Isrow6, Sara J Zakem7, Joshua Dault8, Musaddiq J Awan9, Kristin A Higgins10, Comron Hassanadeh11, Jonathan J Beitler12, Chandana A Reddy2, Samuel Marcrom13, Drexell H Boggs13, James A Bonner13, Min Yao9, Mitchell Machtay9, Farzan Siddiqui6, Andy M Trotti3, Nancy Y Lee4, Shlomo A Koyfman2, Robert L Ferris14, Dwight E Heron15. 1. Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania. 2. Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio. 3. Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. 4. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. 5. Department of Radiation Oncology, University of Louisville, Louisville, Kentucky. 6. Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan. 7. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio. 8. Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia. 9. Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio. 10. Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia. 11. School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri. 12. Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia; Department of Otolaryngology Head and Neck Surgery, Emory University, Atlanta, Georgia. 13. Department of Radiation Oncology, University of Alabama, Birmingham, Birmingham, Alabama. 14. Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania; Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania. 15. Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania; Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania. Electronic address: herond2@umpc.edu.
Abstract
PURPOSE: Two modern methods of reirradiation, intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), are established for patients with recurrent or second primary squamous cell carcinoma of the head and neck (rSCCHN). We performed a retrospective multi-institutional analysis to compare methods. METHODS AND MATERIALS: Data from patients with unresectable rSCCHN previously irradiated to ≥40 Gy who underwent reirradiation with IMRT or SBRT were collected from 8 institutions. First, the prognostic value of our IMRT-based recursive partitioning analysis (RPA) separating those patients with unresectable tumors with an intertreatment interval >2 years or those with ≤2 years and without feeding tube or tracheostomy dependence (class II) from other patients with unresected tumors (class III) was investigated among SBRT patients. Overall survival (OS) and locoregional failure were then compared between IMRT and SBRT by use of 2 methods to control for baseline differences: Cox regression weighted by the inverse probability of treatment and subset analysis by RPA classification. RESULTS: The study included 414 patients with unresectable rSCCHN: 217 with IMRT and 197 with SBRT. The unadjusted 2-year OS rate was 35.4% for IMRT and 16.3% for SBRT (P<.01). Among SBRT patients, RPA classification retained an independent association with OS. On Cox regression weighted by the inverse probability of treatment, no significant differences in OS or locoregional failure between IMRT and SBRT were demonstrated. Analysis by RPA class showed similar OS between IMRT and SBRT for class III patients. In all class II patients, IMRT was associated with improved OS (P<.001). Further subset analysis demonstrated comparable OS when ≥35 Gy was delivered with SBRT to small tumor volumes. Acute grade ≥4 toxicity was greater in the IMRT group than in the SBRT group (5.1% vs 0.5%, P<.01), with no significant difference in late toxicity. CONCLUSIONS: Reirradiation both with SBRT and with IMRT appear relatively safe with favorable toxicity compared with historical studies. Outcomes vary by RPA class, which informs clinical trial design. Survival is poor in class III patients, and alternative strategies are needed.
PURPOSE: Two modern methods of reirradiation, intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), are established for patients with recurrent or second primary squamous cell carcinoma of the head and neck (rSCCHN). We performed a retrospective multi-institutional analysis to compare methods. METHODS AND MATERIALS: Data from patients with unresectable rSCCHN previously irradiated to ≥40 Gy who underwent reirradiation with IMRT or SBRT were collected from 8 institutions. First, the prognostic value of our IMRT-based recursive partitioning analysis (RPA) separating those patients with unresectable tumors with an intertreatment interval >2 years or those with ≤2 years and without feeding tube or tracheostomy dependence (class II) from other patients with unresected tumors (class III) was investigated among SBRT patients. Overall survival (OS) and locoregional failure were then compared between IMRT and SBRT by use of 2 methods to control for baseline differences: Cox regression weighted by the inverse probability of treatment and subset analysis by RPA classification. RESULTS: The study included 414 patients with unresectable rSCCHN: 217 with IMRT and 197 with SBRT. The unadjusted 2-year OS rate was 35.4% for IMRT and 16.3% for SBRT (P<.01). Among SBRT patients, RPA classification retained an independent association with OS. On Cox regression weighted by the inverse probability of treatment, no significant differences in OS or locoregional failure between IMRT and SBRT were demonstrated. Analysis by RPA class showed similar OS between IMRT and SBRT for class III patients. In all class II patients, IMRT was associated with improved OS (P<.001). Further subset analysis demonstrated comparable OS when ≥35 Gy was delivered with SBRT to small tumor volumes. Acute grade ≥4 toxicity was greater in the IMRT group than in the SBRT group (5.1% vs 0.5%, P<.01), with no significant difference in late toxicity. CONCLUSIONS: Reirradiation both with SBRT and with IMRT appear relatively safe with favorable toxicity compared with historical studies. Outcomes vary by RPA class, which informs clinical trial design. Survival is poor in class III patients, and alternative strategies are needed.
Authors: Thomas Held; Thomas Tessonnier; Henrik Franke; Sebastian Regnery; Lukas Bauer; Katharina Weusthof; Semi Harrabi; Klaus Herfarth; Andrea Mairani; Jürgen Debus; Sebastian Adeberg Journal: Radiat Oncol Date: 2022-07-08 Impact factor: 4.309
Authors: J Boustani; A Ruffier; A Moya-Plana; Y Tao; F Nguyen; C Even; C Berthold; O Casiraghi; S Temam; P Blanchard Journal: Strahlenther Onkol Date: 2020-06-08 Impact factor: 3.621
Authors: Jimmy J Caudell; Matthew C Ward; Nadeem Riaz; Sara J Zakem; Musaddiq J Awan; Neal E Dunlap; Derek Isrow; Comron Hassanzadeh; John A Vargo; Dwight E Heron; Samuel Marcrom; Drexell H Boggs; Chandana A Reddy; Joshua Dault; James A Bonner; Kristin A Higgins; Jonathan J Beitler; Shlomo A Koyfman; Mitchell Machtay; Min Yao; Andy M Trotti; Farzan Siddiqui; Nancy Y Lee Journal: Int J Radiat Oncol Biol Phys Date: 2017-12-01 Impact factor: 7.038
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Authors: Mauricio E Gamez; Samir H Patel; Lisa A McGee; Terence T Sio; Mark McDonald; Jack Phan; Daniel J Ma; Robert L Foote; Jean-Claude M Rwigema Journal: Int J Part Ther Date: 2021-06-25
Authors: Matthew C Ward; Nadeem Riaz; Jimmy J Caudell; Neal E Dunlap; Derek Isrow; Sara J Zakem; Joshua Dault; Musaddiq J Awan; John A Vargo; Dwight E Heron; Kristin A Higgins; Jonathan J Beitler; Samuel Marcrom; Drexell H Boggs; Comron Hassanzadeh; Chandana A Reddy; James A Bonner; Min Yao; Mitchell Machtay; Farzan Siddiqui; Andy M Trotti; Nancy Y Lee; Shlomo A Koyfman Journal: Int J Radiat Oncol Biol Phys Date: 2017-06-17 Impact factor: 8.013
Authors: Alexander Lin; John H C Chang; Ryan S Grover; Frank J P Hoebers; Upendra Parvathaneni; Samir H Patel; Juliette Thariat; David J Thomson; Johannes A Langendijk; Steven J Frank Journal: Int J Part Ther Date: 2021-06-25