Comprehensive volume hyperfractionated (HFx) re-irradiation (Re-RT) of recurrent head and neck (H/N) cancer is feasible.

Abstract

5551 Background: A retrospective review of patients with recurrent head and neck (H/N) cancer treated with comprehensive volume re-irradiation (Re-RT) was conducted. Methods: Between 2003 and 2009, 23 patients underwent Re-RT for recurrent H/N cancer. Sites included the larynx (n=4), oropharynx (n=5), oral cavity (n=8), and other (n=5) non-nasopharynx sites. Unlike other published reports of head and neck Re-RT, patients Re-RT at USC received comprehensive volume (primary site of recurrence, involved nodal disease and bilateral draining nodal regions) hyperfractionated (HFx) RT (at 110-120 cGy/fx BID with at least a 6 hour interval to total planned dose of 7,680-7,700 cGy) with no planned treatment breaks. 17% of the patients were treated palliatively. The median dose of previous RT was 6680 cGy (range 5,040-7,200cGy), and the median interval from the initial RT was 17 months (6-228 mos). Only two patients received concurrent chemotherapy [cisplatin (n=1), erbitux (n=1)]. Results: The median Re-RT dose was 7320cGy (3240cGy – 7700 cGy). The median duration of treatment was 49 days, and the median number of break days was 6 (0-26 d). Ten (43%) of the 23 patients completed their planned HFx Re-RT without any treatment related breaks. 18 patients required a treatment related break of 1 week or less, while 5 patients needed a treatment related break of more than 1 week due to PEG placement (n=3), infection (n=1) and mucositis (n=1). Major acute toxicities consisted of grade 3 mucositis in 17% of patients and grade 3 skin desquamation in 22%. No patients were lost to follow up. The median overall survival after Re-RT was 3 months (range 0-26 months). One patient is alive and cNED at 26 months. Another patient died cNED at 26 months from a non-cancer related cause. Eight patients died secondary to metastatic disease and 4 more patients chose hospice after completing palliative Re-RT. Only 4 patients treated curatively experienced documented local failure. Conclusions: Comprehensive volume HFx Re-RT with no planned treatment breaks is feasible and tolerable. Based upon our institutional experience, we plan to initiate a phase I/II trial testing comprehensive volume Re-RT in patients with recurrent H/N cancer.