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

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.

Long-Term Safety and Efficacy of CT-Guided I125 Radioactive Seed Implantation as a Salvage Therapy for Recurrent Head and Neck Squamous Carcinoma: A Multicenter Retrospective Study

“…With the development of modern radiation techniques, such as 3-dimensional conformal radiotherapy (3D-CRT) or intensify modulated radiotherapy (IMRT), reirradiation is applied for rHNSC after EBRT. Reirradiation using EBRT with or without chemotherapy improved the local control rates in half of the patients and long-term survival in selected patients ( 19 , 20 ). EBRT as a salvage option is promising for rHNSC in the previously irradiated area although it still poses a great challenge as it is hard to deliver sufficient doses to the targets while sparing the normal tissues, especially for tumors previously treated with full doses.…”

Multidisciplinary Management of Radiation-Induced Salivary Gland Carcinomas in the Modern Radiotherapy Era

“…On the other hand, Mallik et al reported 47 submandibular gland cancers, mostly ACCs, with a 5-year DFS of 71.8%, 12.8% (n = 6) of loco-regional failure, and 12.8% (n = 6) of development of distant metastases. Compared to the past, availability of new effective systemic treatments (e.g., androgen deprivation therapy, ADT; anti-HER2 monoclonal antibody), improvement in the re-irradiation (reRT) [19] techniques and the opening of heavy ions facility in Italy in 2011 have offered new therapeutic opportunities.…”

“…In regards to IMRT, most of the experience in literature refers to mixed series where the number of SGCs is significantly lower than pharyngeal or laryngeal squamous cell carcinoma cases [19,43,44]. Recently, Orlandi et al analyzed reRT outcomes on a cohort of 159 patients, of which 71 (45%) were not squamous cell carcinomas (in particular, 25 (16%) were ACC and 8 (5%) were affected by SGCs).…”

“…One of these patients had two synchronous secondary SGCs after a LT of 34 years, for a total of 14 ri-SGC cases. Median age at diagnosis of primary tumor was 17 years (range 3-68), whereas median age at diagnosis of ri-SGC was 50 years (range 17-78), with a median interval between radiation exposure and diagnosis of the SGCs of 23 years (95% CI: [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

Re-Irradiation for Local Relapses or Second Primaries: When and how?

“…Outcomes also correlate with the site of recurrence with nasopharyngeal and laryngeal cancer revealing a better prognosis [23,[28][29][30][31][32]. Generally, nasopharyngeal tumors have a higher radiosensitivity which could be also an explanation for its favorable prognosis with Re-RT.…”