Recurrence patterns of locally advanced head and neck squamous cell carcinoma after 3D conformal (chemo)-radiotherapy

Abstract

BackgroundTo establish recurrence patterns among locally advanced head and neck non-nasopharyngeal squamous cell carcinoma (HNSCC) patients treated with radical (chemo-) radiotherapy and to correlate the sites of loco-regional recurrence with radiotherapy doses and target volumesMethod151 locally advanced HNSCC patients were treated between 2004-2005 using radical three-dimensional conformal radiotherapy. Patients with prior surgery to the primary tumour site were excluded. The sites of locoregional relapses were correlated with radiotherapy plans by the radiologist and a planning dosimetrist.ResultsMedian age was 59 years (range:34-89). 35 patients had stage III disease, 116 patients had stage IV A/B. 36 patients were treated with radiotherapy alone, 42 with induction chemotherapy, 63 with induction and concomitant chemoradiotherapy and 10 concomitant chemoradiotherapy. Median follow-up was 38 months (range 3-62). 3-year cause specific survival was 66.8%. 125 of 151 (82.8%) achieved a complete response to treatment. Amongst these 125 there were 20 local-regional recurrence, comprising 8 local, 5 regional and 7 simultaneous local and regional; synchronous distant metastases occurred in 7 of the 20. 9 patients developed distant metastases in the absence of locoregional failure. For the 14 local recurrences with planning data available, 12 were in-field, 1 was marginal, and 1 was out-of-field. Of the 11 regional failures with planning data available, 7 were in-field, 1 was marginal and 3 were out-of-field recurrences.ConclusionThe majority of failures following non-surgical treatment for locally advanced HNSCC were loco-regional, within the radiotherapy target volume. Improving locoregional control remains a high priority.

Role of Nrf2 signaling pathway in the radiation tolerance of patients with head and neck squamous cell carcinoma: an in vivo and in vitro study

“…Meanwhile, conventional treatments often lead to side effects that could affect normal physiological functions, such as swallowing, speech and physical appearance 4. Accordingly, radiotherapy has become a commonly accepted alternative for HNSCC treatment 6. Unfortunately, some patients with HNSCC develop chemo- and radioresistance, and only 50%–60% of them treated with radiation and chemotherapy are cured of their disease 7.…”

Methods for estimating the site of origin of locoregional recurrence in head and neck squamous cell carcinoma

“…One approach has been to determine the site of recurrence origin directly on the treatment planning scan [9]. Other studies have transferred the delineated recurrence volume by coregistration or expert opinion to the treatment planning scan and ascribed the recurrence to the highest isodose level encompassing either 50% or 95% of the recurrence volume [6,13,17,18,19]. The volume overlap method has some inherent weaknesses, especially when the purpose is to analyze the relation of the recurrence to small regions, and we recently published a pilot study introducing the concept of a focal method in order to analyze the pattern of failure with a spatial resolution matching the achievable dose modulation in dose-painted radiotherapy [5].…”

Identification des sites de récidive sur la TEP/TDM initiale dans les cancers des VADS traités par radiochimiothérapie

“…Dans les formes localement avancées traitées par radiothérapie, Oksuz et al ont par exemple observé 12 % de récidives en réalisant des TDM de façon systématique [25]. Lors d'un suivi moyen de 16 mois, nous avons enregistré 13 % de récidive ganglionnaire et/ou métastatique sans récidive locale et 37 % de réponse tumorale incomplète ou de récidive locale.…”