Optimising (re-)irradiation for Locally Recurrent Head and Neck Cancer: Impact of Dose-escalation, Salvage Surgery, PEG Tube and Biomarkers on Oncological Outcomes-a Single Centre Analysis

Overview

Journal Radiat Oncol

Publisher Biomed Central

Specialties Oncology
Radiology

Date 2025 Jan 3

PMID 39748422

Authors

Julia Katharina Schleifenbaum

Janis Morgenthaler

Shachi Jenny Sharma

Jens Peter Klussmann

Philipp Linde

Simone Wegen

Johannes Rosenbrock

Christian Baues

Emmanouil Fokas

Richard Khor

Sweet Ping Ng

Simone Marnitz

Maike Trommer

Affiliations

Soon will be listed here.

Abstract

Introduction: Locoregional recurrence (LR) is common in locally advanced head and neck cancer (HNSCC), posing challenges for treatment. We analysed outcome parameters and toxicities for patients being treated with radiotherapy (RT) for LR-HNSCC and investigated patient and disease related prognostic factors in this prognostically unfavourable group.

Methods: This analysis includes 101 LR-HNSCC patients treated with RT, radio-chemotherapy (RCT) or radio-immunotherapy (RIT) between 2010 and 2018 at a high-volume tertiary centre. Patient characteristics, tumour and treatment details were retrospectively collected. Overall survival (OS), progression-free survival (PFS) and toxicities according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0 were assessed.

Results: 62% of patients were radiotherapy-naïve (initial RT group) while 38% were re-irradiated at site of LR (re-RT group). Median OS for initial RT was 24 months, for re-RT 12 months (p < 0.01). In the RCT subgroup, patients with initial RT had significantly longer OS with 35 months compared to re-RT 12 months (p < 0.05). Patients with UICC grade IV tumours and percutaneous endoscopic gastrostomy (PEG) tube had significantly shorter OS in multivariate analysis: initial RT 13 vs. re-RT 32 months and initial RT 12 vs. re-RT 32 months respectively. Salvage surgery before RT at recurrence was a positive prognostic factor for OS (initial RT 35 vs. re-RT 12 months). Other significant factors for longer OS in univariate analysis included low inflammatory status (Glasgow Prognostic Score 0) and radiation doses ≥ 50 Gy. We detected 37 (15%) ≥ CTCAE Grade 3 events for initial RT and 19 (15%) for re-RT patients.

Conclusion: In this analysis, we identified key prognostic factors including PEG tube and inflammation status that could guide treatment decision. Our findings suggest salvage surgery as preferred treatment option with postoperative RT at LR. Adverse events due to re-RT were acceptable. A radiation dose of ≥ 50 Gy should be administered to achieve better outcomes.

References

Wang C, McIntyre J . Re-irradiation of laryngeal carcinoma--techniques and results. Int J Radiat Oncol Biol Phys. 1993; 26(5):783-5. DOI: 10.1016/0360-3016(93)90492-e. View

Caudell J, Ward M, Riaz N, Zakem S, Awan M, Dunlap N . Volume, Dose, and Fractionation Considerations for IMRT-based Reirradiation in Head and Neck Cancer: A Multi-institution Analysis. Int J Radiat Oncol Biol Phys. 2018; 100(3):606-617. PMC: 7269162. DOI: 10.1016/j.ijrobp.2017.11.036. View

Bentzen S, Constine L, Deasy J, Eisbruch A, Jackson A, Marks L . Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl):S3-9. PMC: 3431964. DOI: 10.1016/j.ijrobp.2009.09.040. View

Brodin N, Tome W . Revisiting the dose constraints for head and neck OARs in the current era of IMRT. Oral Oncol. 2018; 86:8-18. PMC: 6481934. DOI: 10.1016/j.oraloncology.2018.08.018. View

Bachar G, Goh C, Goldstein D, OSullivan B, Irish J . Long-term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy. Eur Arch Otorhinolaryngol. 2009; 267(2):295-301. DOI: 10.1007/s00405-009-1070-0. View

Deurloo E, Schultze Kool L, Kroger R, van Coevorden F, Balm A . Percutaneous radiological gastrostomy in patients with head and neck cancer. Eur J Surg Oncol. 2001; 27(1):94-7. DOI: 10.1053/ejso.2000.1026. View

McMillan D, Crozier J, Canna K, Angerson W, McArdle C . Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis. 2007; 22(8):881-6. DOI: 10.1007/s00384-006-0259-6. View

Dawson L, Myers L, Bradford C, Chepeha D, Hogikyan N, Teknos T . Conformal re-irradiation of recurrent and new primary head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001; 50(2):377-85. DOI: 10.1016/s0360-3016(01)01456-0. View

Brouwer C, Steenbakkers R, Bourhis J, Budach W, Grau C, Gregoire V . CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol. 2015; 117(1):83-90. DOI: 10.1016/j.radonc.2015.07.041. View

10.

Orlandi E, Bonomo P, Ferella L, DAngelo E, Maddalo M, Alterio D . Long-term outcome of re-irradiation for recurrent or second primary head and neck cancer: A multi-institutional study of AIRO-Head and Neck working group. Head Neck. 2019; 41(10):3684-3692. DOI: 10.1002/hed.25890. View

11.

Bhandare N, Jackson A, Eisbruch A, Pan C, Flickinger J, Antonelli P . Radiation therapy and hearing loss. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl):S50-7. PMC: 3319461. DOI: 10.1016/j.ijrobp.2009.04.096. View

12.

Gregoire V, Ang K, Budach W, Grau C, Hamoir M, Langendijk J . Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol. 2013; 110(1):172-81. DOI: 10.1016/j.radonc.2013.10.010. View

13.

Milano M, Vokes E, Salama J, Stenson K, Kao J, Witt M . Twice-daily reirradiation for recurrent and second primary head-and-neck cancer with gemcitabine, paclitaxel, and 5-fluorouracil chemotherapy. Int J Radiat Oncol Biol Phys. 2005; 61(4):1096-106. DOI: 10.1016/j.ijrobp.2004.08.029. View

14.

Powell S, Gold K, Gitau M, Sumey C, Lohr M, McGraw S . Safety and Efficacy of Pembrolizumab With Chemoradiotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma: A Phase IB Study. J Clin Oncol. 2020; 38(21):2427-2437. PMC: 7365766. DOI: 10.1200/JCO.19.03156. View

15.

Proctor M, Morrison D, Talwar D, Balmer S, OReilly D, Foulis A . An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer. 2011; 104(4):726-34. PMC: 3049591. DOI: 10.1038/sj.bjc.6606087. View

16.

Langer C, Harris J, Horwitz E, Nicolaou N, Kies M, Curran W . Phase II study of low-dose paclitaxel and cisplatin in combination with split-course concomitant twice-daily reirradiation in recurrent squamous cell carcinoma of the head and neck: results of Radiation Therapy Oncology Group Protocol 9911. J Clin Oncol. 2007; 25(30):4800-5. DOI: 10.1200/JCO.2006.07.9194. View

17.

Alterio D, Marvaso G, Ferrari A, Volpe S, Orecchia R, Jereczek-Fossa B . Modern radiotherapy for head and neck cancer. Semin Oncol. 2019; 46(3):233-245. DOI: 10.1053/j.seminoncol.2019.07.002. View

18.

Cvek J, Knybel L, Skacelikova E, Stransky J, Matousek P, Zelenik K . Hyperfractionated stereotactic reirradiation for recurrent head and neck cancer. Strahlenther Onkol. 2015; 192(1):40-6. DOI: 10.1007/s00066-015-0886-3. View

19.

Choe K, Haraf D, Solanki A, Cohen E, Seiwert T, Stenson K . Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation. Cancer. 2011; 117(20):4671-8. DOI: 10.1002/cncr.26084. View

20.

Guigay J, Fayette J, Dillies A, Sire C, Kerger J, Tennevet I . Cetuximab, docetaxel, and cisplatin as first-line treatment in patients with recurrent or metastatic head and neck squamous cell carcinoma: a multicenter, phase II GORTEC study. Ann Oncol. 2015; 26(9):1941-1947. DOI: 10.1093/annonc/mdv268. View