Reirradiation of head and neck cancer using modern highly conformal techniques

Ho, Jennifer; Phan, Jack

doi:10.1002/hed.25180

Cited by 40 publications

(30 citation statements)

References 70 publications

(205 reference statements)

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“…Earlier studies using conventional fractionation or brachytherapy in previously irradiated tissues often showed poor to modest local control but at a costly trade-off of highly morbid late complications such as soft tissue necrosis, osteoradionecrosis and carotid blowout. 75–77 IMRT and stereotactic body radiotherapy (SBRT), the latter being a conformal photon-based modality capable of delivering ablative radiation doses over 1–5 fractions with greater dose fall-off than IMRT, have largely replaced traditional 2D/3D RT techniques. Reported 1- to 2-year LRC rates in the literature are approximately 20–60% with 3D RT, 50–60% with IMRT, and 40–80% with SBRT.…”

Section: Clinical Experience With Impt By Head and Neck Sub-sitesmentioning

confidence: 99%

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Intensity modulated proton therapy (IMPT) – The future of IMRT for head and neck cancer

et al. 2019

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Summary Radiation therapy plays an integral role in the management of head and neck cancers (HNCs). While most HNC patients have historically been treated with photon-based radiation techniques such as intensity modulated radiation therapy (IMRT), there is a growing awareness of the potential clinical benefit of proton therapy over IMRT in the definitive, postoperative and reirradiation settings given the unique physical properties of protons. Intensity modulated proton therapy (IMPT), also known as “pencil beam proton therapy,” is a sophisticated mode of proton therapy that is analogous to IMRT and an active area of investigation in cancer care. Multifield optimization IMPT allows for high quality plans that can target superficially located HNCs as well as large neck volumes while significantly reducing integral doses. Several dosimetric studies have demonstrated the superiority of IMPT over IMRT to improve dose sparing of nearby organs such as the larynx, salivary glands, and esophagus. Evidence of the clinical translation of these dosimetric advantages has been demonstrated with documented toxicity reductions (such as decreased feeding tube dependency) after IMPT for patients with HNCs. While there are relative challenges to IMPT planning that exist today such as particle range uncertainties and high sensitivity to anatomical changes, ongoing investigations in image-guidance techniques and robust optimization methods are promising. A systematic approach towards utilizing IMPT and additional prospective studies are also necessary in order to more accurately estimate the clinical benefit of IMPT over IMRT and passive proton therapy on a case-by-case basis for patients with sub-site specific HNCs.

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Section: Clinical Experience With Impt By Head and Neck Sub-sitesmentioning

confidence: 99%

“…Reported 1- to 2-year LRC rates in the literature are approximately 20–60% with 3D RT, 50–60% with IMRT, and 40–80% with SBRT. 77…”

Section: Clinical Experience With Impt By Head and Neck Sub-sitesmentioning

confidence: 99%

Intensity modulated proton therapy (IMPT) – The future of IMRT for head and neck cancer

et al. 2019

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“…[12][13][14] Therefore, IMRT is an attractive modality for locally advanced HNC with regard to improving therapeutic ratio compared with three-dimensional conformal RT even in a recurrent setting. 15,16 During the past two decades, clinical investigators published a number of studies to assess the efficacy of IMRT for recurrent or secondary HNC.…”

Section: Introductionmentioning

confidence: 99%

Reirradiation with intensity‐modulated radiation therapy for recurrent or secondary head and neck cancer: Meta‐analysis and systematic review

et al. 2020

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Background To summarize outcomes of reirradiation with intensity‐modulated radiotherapy (IMRT) for recurrent or secondary head and neck cancer (HNC). Methods Primary endpoints were 2‐year local control (LC) and overall survival (OS). Studies involving only recurrent nasopharyngeal patients with cancer were excluded. Results A total of 17 studies involving 1635 patients were included. Fourteen (82%) of those were retrospective, and 15 (88%) were from single institution. Reirradiation with IMRT produced pooled 2‐year LC and OS rates of 52% (95% confidence interval [CI], 46%‐57%) and 46% (95% CI, 41%‐50%), respectively. In subgroup analyses, the rate of salvage surgery (<42% vs ≥42%) influenced the pooled 2‐year LC rate (45.9% vs 58.5%, P = .011). The pooled rates of late grade ≥ 3 and grade 5 toxicities were 26% (95% CI, 20%‐32%) and 3.1% (95% CI, 2%‐5%), respectively. Conclusions Reirradiation with IMRT was an effective modality compared to historical outcomes in the pre‐IMRT era.

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“…Recurrent oropharyngeal squamous cell carcinomas in particular have high rates of relapse and treatment‐related toxicity such as severe dysphagia, fibrosis, and soft tissue/bone necrosis following curative‐intent reirradiation 4 . Factors including tumor volume, reirradiation dose, and receipt of systemic therapy have been associated with rates of relapse and treatment‐related toxicity in multiple retrospective studies 5 . In general, higher reirradiation doses and use of concurrent systemic therapy have been associated with improved local control (LC) rates, but these data are likely influenced by patient selection factors inherent to retrospective studies.…”

Section: Introductionmentioning

confidence: 99%

Highly conformal reirradiation in patients with prior oropharyngeal radiation: Clinical efficacy and toxicity outcomes

et al. 2020

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Background: Reirradiation of head and neck cancer is associated with high rates of locoregional failure and potentially severe treatment-related toxicity. We report our institutional experience of reirradiation using modern highly conformal radiotherapy approaches in patients with prior oropharyngeal radiation. Methods: We reviewed patients receiving curative-intent reirradiation with intensity-modulated radiation therapy, stereotactic body radiation therapy, and proton beam radiotherapy at our institution from 1999 to 2019. Disease control, survival, and toxicity rates following reirradiation were determined. Results: Sixty-nine patients were evaluated. Local control (LC), progression-free survival, and overall survival at 2 years following reirradiation were 77%, 35%, and 51%, respectively. Grade 3 or greater (G3+) late toxicities occurred in 46% of patients and 41% required feeding tube placement during or after reirradiation. Conclusions: In select patients with prior oropharyngeal radiation, highly conformal reirradiation offers acceptable LC, but G3+ toxicity and out-of-field failure rates remain high. These findings warrant continued evaluation of new multimodality approaches to improve oncologic outcomes.

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Reirradiation of head and neck cancer using modern highly conformal techniques

Cited by 40 publications

References 70 publications

Intensity modulated proton therapy (IMPT) – The future of IMRT for head and neck cancer

Intensity modulated proton therapy (IMPT) – The future of IMRT for head and neck cancer

Reirradiation with intensity‐modulated radiation therapy for recurrent or secondary head and neck cancer: Meta‐analysis and systematic review

Highly conformal reirradiation in patients with prior oropharyngeal radiation: Clinical efficacy and toxicity outcomes

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