Re-Irradiation for Head and Neck Cancer: Cumulative Dose to Organs at Risk and Late Side Effects

Embring, Anna; Onjukka, Eva; Mercke, Claes; Lax, Ingmar; Berglund, Anders; Bornedal, Sara; Wennberg, Berit; Dalqvist, Emmy; Friesland, Signe

doi:10.3390/cancers13133173

Cited by 21 publications

(23 citation statements)

References 32 publications

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“…Our results also showed that re-irradiation is associated with a higher risk of significant CAS development. This echoed the study showing an association between cumulative dose to organs at risk and the risk of developing carotid blowout syndrome [38]. PBT emerges as having a role for radiotherapy in the treatment of NPC more so than in the treatment of oral cavity or laryngeal cancer [39], and nearly half of the patients with NPC in the present study underwent PBT.…”

Section: Discussionsupporting

confidence: 74%

Head and Neck Cancer Types and Risks of Cervical–Cranial Vascular Complications within 5 Years after Radiation Therapy

Liu

Huang

Lin

et al. 2022

JPM

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Background and purpose: to investigate the frequency of cervical–cranial vascular complications soon after radiation therapy (RT) and identify differences among patients with various types of head and neck cancer (HNC). Methods: We enrolled 496 patients with HNC who had received their final RT dose in our hospital. These patients underwent carotid duplex ultrasound (CDU) for monitoring significant carotid artery stenosis (CAS). Brain imaging were reviewed to detect vertebral, intracranial artery stenosis, or preexisted CAS before RT. Primary outcome was significant CAS at the internal or common carotid artery within first 5 years after RT. We categorized the patients into nasopharyngeal carcinoma (NPC) and non-NPC groups and compared the cumulative occurrence of significant CAS between the groups using Kaplan–Meier and Cox-regression analyses. Results: Compared to the NPC group, the non-NPC group had a higher frequency of significant CAS (12.7% vs. 2.0%) and were more commonly associated with significant CAS after adjusting the covariates (Adjusted hazard ratio: 0.17, 95% confident interval: 0.05–0.57) during the follow-up period. All the non-NPC subtypes (oral cancer/oropharyngeal, hypopharyngeal, and laryngeal cancers) were associated with higher risks of significant CAS than the NPC group (p < 0.001 respectively). Conclusion: Significant CAS was more frequently noted within 5 years of RT among the patients with non-NPC HNC than among the patients with NPC. Scheduled carotid artery surveillance and vascular risk monitoring should be commenced earlier for patients with non-NPC HNC. By contrast, vascular surveillance could be deferred to 5 years after RT completion in NPC patients.

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Section: Discussionsupporting

confidence: 74%

Head and Neck Cancer Types and Risks of Cervical–Cranial Vascular Complications within 5 Years after Radiation Therapy

Liu

Huang

Lin

et al. 2022

JPM

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“…The equivalent dose represents the product of the dose absorbed by a tissue and a radiation weighting factor, used to measure the effect of IR 31 . In medicine, the equivalent dose is expressed in millisieverts (mSv) 32 . The risk of cancer induced by radiation occurs at doses above 100 mSv, controversial at doses between 10 and 100 mSv and below 10 mSv, there is no data [31][32][33] .…”

Section: Discussionmentioning

confidence: 99%

Impact of ionizing radiation secondary to computed tomography on the development of neoplasms: A scoping review

Tuta-Quintero¹,

Collazos-Bahamon²,

Orozco-Bejarano³

et al. 2022

GAMO

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Ionizing radiation (IR), energy transported through rays, and particles emitted can increase the risk of developing cancer. We conducted a scoping review using PubMed and Scopus about association between radiation exposure when performing a computed tomography (CT) scan and the risk of developing a malignant and/or benign neoplastic process. Some 17 retrospective cohort studies and two cross-sectional studies were included in the study. The malignant tumors associated with IR included leukemia and brain, thyroid, head, and neck cancer, mainly in patients under 18 years of age exposed to more than two CT scans of the head, chest, and abdominopelvic regions. Therefore, the studies described a higher risk of developing cancer in subjects exposed to the IR of a CT, with a focus on the pediatric population, female gender, and repeated exposures. It is necessary to conduct a greater number of clinical studies that include a longer follow-up time, broader types of neoplasms, and population-based subgroup analysis.

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“…The possibility of unacceptably high severe toxicity, even leading to lethal catastrophic arterial rupture or carotid blow-out syndrome [ 6 ], should be anticipated. Recently, a few dose-volume constraints for each organ at risk from reirradiation have been proposed [ 16 , 17 ], one of which included considering temporally-based dose recovery parameters or “discount” factors with time [ 16 ]. When considering reirradiation, radiation oncologists must make difficult clinical decisions depending mainly on their own experiences due to the lack of high-level evidence for reirradiation.…”

Section: Discussionmentioning

confidence: 99%

“…When considering reirradiation, radiation oncologists must make difficult clinical decisions depending mainly on their own experiences due to the lack of high-level evidence for reirradiation. There are several considerations to help in decision-making, such as (i) normal tissue tolerability [ 11 , 16 , 17 ], (ii) availability of technical data from the first radiotherapy, (iii) radical or palliative intent related to the prognosis, and (iv) reirradiation schedule including the dose fractionation-volume relationship. Such decisions must be made by multidisciplinary teams with expertise in radiotherapy and implemented on carefully selected patients.…”

Section: Discussionmentioning

confidence: 99%

Reirradiation for Nasal Cavity or Paranasal Sinus Tumor—A Multi-Institutional Study

Yamazaki

Suzuki

Aibe

et al. 2021

Cancers

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We evaluated the efficacy and toxicity of reirradiation of nasal cavity or paranasal sinus tumors. We collected and analyzed multi-institutional data of reirradiation cases. Seventy-eight patients with nasal or paranasal sinus tumors underwent reirradiation. The median survival time was 20 months with a medial follow-up of 10.7 months. The 2-year local control and overall survival rates were 43% and 44%, respectively. Tumor volume (≤25 cm3), duration between previous radiotherapy and reirradiation (≤12 months), histology (squamous cell carcinoma), male sex, and lymph node involvement were predisposing factors for poor survival. Distant metastasis was observed in 20 patients (25.6%). Grade ≥ 3 adverse events were observed in 22% of the patients, including five grade 4 (8.6%) cases and one grade 5 (1.2%) case. Tumor location adjacent to the optic pathway was a significant predisposing factor for grade ≥3 visual toxicity. Reirradiation of nasal and paranasal sinus tumors is feasible and effective. However, adverse events, including disease-related toxicities, were significant. Prognostic factors emerge from this study to guide multidisciplinary approaches and clinical trial designs.

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Re-Irradiation for Head and Neck Cancer: Cumulative Dose to Organs at Risk and Late Side Effects

Cited by 21 publications

References 32 publications

Head and Neck Cancer Types and Risks of Cervical–Cranial Vascular Complications within 5 Years after Radiation Therapy

Head and Neck Cancer Types and Risks of Cervical–Cranial Vascular Complications within 5 Years after Radiation Therapy

Impact of ionizing radiation secondary to computed tomography on the development of neoplasms: A scoping review

Reirradiation for Nasal Cavity or Paranasal Sinus Tumor—A Multi-Institutional Study

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