Results of postoperative reirradiation for recurrent or second primary head and neck carcinoma

Abstract

BACKGROUNDIn this prospective study, the effects of a second course of postoperative radiation therapy on locoregional control, survival, toxicity, and quality of life were investigated in patients who underwent resection of a second primary or locoregional recurrent head and neck tumor in a previously irradiated area.METHODSIn total, 39 patients who underwent surgery for second primary tumors (n = 19 patients) or for recurrent locoregional tumors (n = 20 patients) were retreated with postoperative radiotherapy (RE‐PORT). Indications for RE‐PORT were extranodal spread (49%), positive surgical margins (44%), and/or other risk factors (8%). The target volume for RE‐PORT was confined to the high‐risk area. No elective radiotherapy was applied in regions that were situated in the formerly high‐dose area. A total dose of 46 grays (Gy) was given to elective areas with boosts from 60 Gy to 66 Gy to the high‐risk region with conventional fractionation. The results of RE‐PORT were compared with the results from patients who were treated in the same period with primary adjuvant radiotherapy (PRI‐PORT) at the authors' institution.RESULTSThe mean follow‐up was 32 months (range, 3‐84 mos). The locoregional control rate after 3 years in the RE‐PORT group was 74%, and the 3‐year overall survival rate was 44%. This did not differ significantly compared with survival rates in the PRI‐PORT group. Although a higher rate of late radiation‐induced morbidity and more head and neck symptoms were observed in the RE‐PORT group compared with the PRI‐PORT group, no differences were observed with regard to the more general dimensions of quality of life.CONCLUSIONSRE‐PORT after surgery for recurrent locoregional tumors and/or second primary tumors should be considered in patients who have high‐risk histopathologic features. Cancer 2006. © 2006 American Cancer Society.

Radiation-induced sarcoma: 25-year experience from The Norwegian Radium Hospital

“…Due to the high incidence of multifocal RIS after breast cancer treatment one may consider to remove the whole irradiated area and not only the tumour [31]. Reirradiation with modern technique should also be considered [32].…”

MR Imaging Criteria for the Prediction of Extranodal Spread of Metastatic Cancer in the Neck

“…1 Extranodal spread (ENS) is one of the high-risk features in patients with head and neck cancer because the presence of ENS is associated with an increase in the incidence of locoregional recurrence and distant metastasis. [2][3][4] CT and MR imaging are frequently used to stage cancer, and CT has been shown to be more accurate than MR imaging.…”

Will Re-irradiation Alone Prevent Loco-regional Progression in Isolated Nodal Recurrence of Nasopharyngeal Carcinoma? - A Case Report

“…Postoperative re-irradiation is indicated in patients who have highrisk pathologic features following surgery such as positive margins, peri-neural invasion, lymphovascular space invasion or extracapsular extension [5][6][7] . Early diagnosis of local recurrence and re-irradiation dose of up to 60 Gy have been found to be crucial for improving local control and survival [8] .…”