Full-dose reirradiation for unresectable head and neck carcinoma: experience at the Gustave-Roussy Institute in a series of 169 patients.

Abstract

Full-dose reirradiation combined with chemotherapy was feasible in patients with inoperable HNC. The incidence and severity of late toxicity was markedly increased in comparison to that observed after the first irradiation. Median survival was better than that generally obtained using palliative chemotherapy alone. A small proportion of patients were long-term disease-free survivors.

Reirradiation of head and neck cancer: Long‐term disease control and toxicity

“…Approximately one fourth of patients included in the current analysis were reirradiated without prior surgery, and 5‐year locoregional control and OS were only 20% and 14%, respectively. Poor outcome for this patient category was also reported by others 18, 19, 22. The dilemma in this situation is that adequate radiation dose for gross disease is often considered not safe and feasible because of the previous radiation treatment.…”

“…Several studies have shown that a longer interval from the last radiotherapy treatment is correlated with an improved survival rate 8, 18. In the current study, in univariate analysis, an improved OS was observed if the time to reirradiation was >3 years (Table 2).…”

“…The importance of long‐term follow‐up for proper estimations of late complication and survival rates has been clearly documented 16, 17. Previously reported 2‐year locoregional control rates after reirradiation range from 10% to 64%, but long‐term follow‐up data are scarce 11, 12, 18, 19, 20, 21. OS rates in these reports vary from 10% to 58% depending on patient selection criteria.…”

Boron Neutron Capture Therapy in the Treatment of Locally Recurred Head-and-Neck Cancer: Final Analysis of a Phase I/II Trial

“…Palliative chemotherapy is regarded as a standard treatment, but full-dose, repeat irradiation is an option for selected patients and may result in durable control in approximately 10% of such patients (4)(5)(6)(7). However, reirradiation with or without concomitant chemotherapy is associated with a risk for severe organ injury due to a high accumulated radiation dose in up to 80% of the patients and treatment-related death in up to 15% (4)(5)(6)(7)(8). Efficient, well-tolerated treatment options are lacking, and patients with unresectable recurrent head-andneck carcinoma pose a difficult therapeutic problem.…”

When is re-irradiation in head and neck squamous cell carcinoma not indicated?

“…In the prospective RTOG 9610 study and two out of three largest retrospective series (each with [100 patients included), the interval since last RT positively correlated with the survival outcome, with the time cut off point usually identified at 36 months [8,9,11,12]. It appears that with regard to re-treatment interval, the premise should be ''longer is better'', although no impact of delay from first irradiation and opposite observations has been reported in the literature [12][13][14]. This rule probably does not apply if the previous radiation missed the area of recurrence.…”