Cancer Res Treat.  2020 Oct;52(4):1031-1040. 10.4143/crt.2020.310.

Intensity-Modulated Radiotherapy-Based Reirradiation for Head and Neck Cancer: A Multi-institutional Study by Korean Radiation Oncology Group (KROG 1707)

• Lee J
• Kim TH
• Kim YS
• Kim M
• Park JW
• Kim SH
• Kim HJ
• Lee CG

• KMID: 2507930
• DOI: http://doi.org/10.4143/crt.2020.310

Abstract

Purpose
The benefits of reirradiation for head and neck cancer (HNC) have not been determined. This study evaluated the efficacy of reirradiation using intensity-modulated radiotherapy (IMRT) for recurrent or second primary HNC (RSPHNC) and identified subgroups for whom reirradiation for RSPHNC is beneficial.
Materials and Methods
A total of 118 patients from seven Korean institutions with RSPHNC who underwent IMRT-based reirradiation between 2006 and 2015 were evaluated through retrospective review of medical records. We assessed overall survival (OS) and local control (LC) within the radiotherapy (RT) field following IMRT-based reirradiation. Additionally, the OS curve according to the recursive partitioning analysis (RPA) suggested by the Multi-Institution Reirradiation (MIRI) Collaborative was determined.
Results
At a median follow-up period of 18.5 months, OS at 2 years was 43.1%. In multivariate analysis, primary subsite, recurrent tumor size, interval between RT courses, and salvage surgery were associated with OS. With regard to the MIRI RPA model, the class I subgroup had a significantly higher OS than class II or III subgroups. LC at 2 years was 53.5%. Multivariate analyses revealed that both intervals between RT courses and salvage surgery were prognostic factors affecting LC. Grade 3 or more toxicity and grade 5 toxicity rates were 8.5% and 0.8%, respectively.
Conclusion
IMRT-based reirradiation was an effective therapeutic option for patients with RSPHNC, especially those with resectable tumors and a long interval between RT courses. Further, our patients' population validated the MIRI RPA classification by showing the difference of OS according to MIRI RPA class.

Keyword

Head and neck neoplasm; Recurrence; Reirradiation; Intensity modulated radiotherapy

Figure

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  Fig. 1. Kaplan-Meier curve of overall survival and local control rates.

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  Fig. 2. Kaplan-Meier curve of overall survival rate according to primary subsite (A), tumor size of recurrent or second primary tumor (B), interval between radiotherapy (RT) courses (C), salvage surgery (D), and recursive partitioning analysis (RPA) classes defined by the Multi-Institution Reirradiation Collaborative (E).

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  Fig. 3. Kaplan-Meier curve of local control rate according to interval between radiotherapy (RT) courses (A) and salvage surgery (B).

Reference

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