The Pattern of Failure After Reirradiation of Recurrent Squamous Cell Head and Neck Cancer: Implications for Defining the Targets

Aron Popovtzer, Iris Gluck, Douglas B. Chepeha, Theodoros N. Teknos, Jeffrey S. Moyer, Mark E. Prince, Carol R. Bradford, Avraham Eisbruch*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

106 Scopus citations

Abstract

Purpose: Reirradiation (re-RT) of recurrent head and neck cancer (HNC) may achieve long-term disease control in some patients, at the expense of high rates of late sequelae. Limiting the re-RT targets to the recurrent gross tumor volume (rGTV) would reduce the volumes of reirradiated tissues; however, its effect on tumor recurrence pattern is unknown. Methods and Materials: This is a retrospective review of 66 patients who underwent curative-intent re-RT for nonresectable recurrent or second primary mucosal squamous cell HNC. Treatment was delivered with three-dimensional conformal (3D) RT or intensity-modulated RT (IMRT). The targets in all patients consisted of the rGTVs with tight (0.5-cm) margins, with no intent to treat prophylactically lymph nodes or subclinical disease in the vicinity of the rGTVs. The sites of locoregional failures (LRFs) were determined using imaging at the time of failure and were compared with the rGTVs. Results: Median re-RT dose was 68 Gy. Forty-seven patients (71%) received concomitant chemotherapy, and 31 (47%) received hyperfractionated, accelerated RT. At a median follow-up of 42 months, 16 (23%) were alive and disease-free. Fifty patients (77%) had a third recurrence or persistent disease, including 47 LRFs. All LRFs occurred within the rGTVs except for two (4%) (95% confidence interval, 0-11%). Nineteen patients (29%) had Grade ≥ 3 late complications, mostly dysphagia (12 patients). Conclusions: Almost all LRFs occurred within the reirradiated rGTVs despite avoiding prophylactic RT of tissue at risk of subclinical disease. These results support confining the re-RT targets to the rGTVs to reduce reirradiated tissue volumes.

Original languageEnglish
Pages (from-to)1342-1347
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume74
Issue number5
DOIs
StatePublished - 1 Aug 2009
Externally publishedYes

Funding

FundersFunder number
National Cancer InstituteP01CA059827

    Keywords

    • 3D radiotherapy
    • IMRT
    • Recurrent head and neck cancer
    • Reirradiation
    • Target definition

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