Konstantin Gordon1, Igor Gulidov2, Alexey Semenov1, Olga Golovanova3, Sergey Koryakin3, Tatyana Makeenkova1, Sergey Ivanov4, Andrey Kaprin5. 1. Department of Proton and Photon Therapy, A. Tsyb Medical Radiological Research Center, Obninsk, Russia. 2. Radiation Therapy Department, A. Tsyb Medical Radiological Research Center, Obninsk, Russia. 3. Radiophysics Department, A. Tsyb Medical Radiological Research Center, Obninsk, Russia. 4. A. Tsyb Medical Radiological Research Center, Obninsk, Russia. 5. National Medical Research Center of Radiology, Obninsk, Russia.
Abstract
BACKGROUND: This study presents a retrospective analysis (efficacy and toxicity) of outcomes in patients with unresectable recurrence of previously irradiated head and neck (H&N) cancers treated with proton therapy. Locoregional recurrence is the main pattern of failure in the treatment of H&N cancers. Proton re-irradiation in patients with relapse after prior radiotherapy might be valid as promising as a challenging treatment option. MATERIALS AND METHODS: From November 2015 to January 2020, 30 patients with in-field recurrence of head and neck cancer, who were not suitable for surgery due to medical contraindications, tumor localization, or extent, received re-irradiation with intensity-modulated proton therapy (IMPT). Sites of retreatment included the aerodigestive tract (60%) and the base of skull (40%). The median total dose of prior radiotherapy was 55.0 Gy. The median time to the second course was 38 months. The median re-irradiated tumor volume was 158.1 cm3. Patients were treated with 2.0, 2.4, and 3.0 GyRBE per fraction, with a median equivalent dose (EQD2) of 57.6 Gy (α/β = 10). Radiation-induced toxicity was recorded according to the RTOG/EORTC criteria. RESULTS: The 1- and 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) were 52.6/21.0, 21.9/10.9, and 73.4/8.4%, respectively, with a median follow-up time of 21 months. The median overall survival was 16 months. Acute grade 3 toxicity was observed in one patient (3.3%). There were five late severe side effects (16.6%), with one death associated with re-irradiation. CONCLUSION: Re-irradiation with a proton beam can be considered a safe and efficient treatment even for a group of patients with unresectable recurrent H&N cancers.
BACKGROUND: This study presents a retrospective analysis (efficacy and toxicity) of outcomes in patients with unresectable recurrence of previously irradiated head and neck (H&N) cancers treated with proton therapy. Locoregional recurrence is the main pattern of failure in the treatment of H&N cancers. Proton re-irradiation in patients with relapse after prior radiotherapy might be valid as promising as a challenging treatment option. MATERIALS AND METHODS: From November 2015 to January 2020, 30 patients with in-field recurrence of head and neck cancer, who were not suitable for surgery due to medical contraindications, tumor localization, or extent, received re-irradiation with intensity-modulated proton therapy (IMPT). Sites of retreatment included the aerodigestive tract (60%) and the base of skull (40%). The median total dose of prior radiotherapy was 55.0 Gy. The median time to the second course was 38 months. The median re-irradiated tumor volume was 158.1 cm3. Patients were treated with 2.0, 2.4, and 3.0 GyRBE per fraction, with a median equivalent dose (EQD2) of 57.6 Gy (α/β = 10). Radiation-induced toxicity was recorded according to the RTOG/EORTC criteria. RESULTS: The 1- and 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) were 52.6/21.0, 21.9/10.9, and 73.4/8.4%, respectively, with a median follow-up time of 21 months. The median overall survival was 16 months. Acute grade 3 toxicity was observed in one patient (3.3%). There were five late severe side effects (16.6%), with one death associated with re-irradiation. CONCLUSION: Re-irradiation with a proton beam can be considered a safe and efficient treatment even for a group of patients with unresectable recurrent H&N cancers.
Authors: Kevin S Choe; Daniel J Haraf; Abhishek Solanki; Ezra E W Cohen; Tanguy Y Seiwert; Kerstin M Stenson; Elizabeth A Blair; Louis Portugal; Victoria M Villaflor; Mary Ellyn Witt; Everett E Vokes; Joseph K Salama Journal: Cancer Date: 2011-06-13 Impact factor: 6.860
Authors: Jack Phan; Terence T Sio; Theresa P Nguyen; Vinita Takiar; G Brandon Gunn; Adam S Garden; David I Rosenthal; Clifton D Fuller; William H Morrison; Beth Beadle; Dominic Ma; Mark E Zafereo; Kate A Hutcheson; Michael E Kupferman; William N William; Steven J Frank Journal: Int J Radiat Oncol Biol Phys Date: 2016-04-13 Impact factor: 7.038
Authors: Sharon A Spencer; Jonathan Harris; Richard H Wheeler; Mitchell Machtay; Christopher Schultz; William Spanos; Marvin Rotman; Ruby Meredith; Kie-Kian Ang Journal: Head Neck Date: 2008-03 Impact factor: 3.147
Authors: Gideon Y Bachar; Christopher Goh; David P Goldstein; Brian O'Sullivan; Jonathan C Irish Journal: Eur Arch Otorhinolaryngol Date: 2010-02 Impact factor: 2.503
Authors: Corey J Langer; Jonathan Harris; Eric M Horwitz; Nicos Nicolaou; Merrill Kies; Walter Curran; Stuart Wong; Kian Ang Journal: J Clin Oncol Date: 2007-10-20 Impact factor: 44.544
Authors: M Lupu-Plesu; A Claren; S Martial; P-D N'Diaye; K Lebrigand; N Pons; D Ambrosetti; I Peyrottes; J Feuillade; J Hérault; M Dufies; J Doyen; G Pagès Journal: Oncogenesis Date: 2017-07-03 Impact factor: 7.485
Authors: Kaley E Woods; Ting Martin Ma; Kiri A Cook; Eric D Morris; Yu Gao; Ke Sheng; Amar U Kishan; John V Hegde; Carol Felix; Vincent Basehart; Kelsey Narahara; Zhouhuizi Shen; Stephen Tenn; Michael L Steinberg; Robert K Chin; Minsong Cao Journal: Cancers (Basel) Date: 2022-02-14 Impact factor: 6.639