Abstract
Purpose: To present a retrospective analysis of the efficacy, toxicity, and quality of life (QoL) of patients treated with OARExtreme-sparing stereotactic body radiotherapy (SBRT) in previously-irradiated head and neck cancer.Materials/Methods: From 11/2012 to 7/2015, 60 patients with in-field recurrence of head and neck cancer underwent re-irradiation with SBRT. Retreatment sites included the aerodigestive tract (43%), lateral neck (22%), and skull base (35%). The median prior RT dose was 63.6 Gy with a median time from prior irradiation of 16.5 months. The median volume treated was 61.0 cc. Patients were treated with 40 Gy in the definitive setting or 35 Gy in the post-operative setting in five fractions. Dose constraints to the OARExtreme were calculated with a BED calculator using an alpha/beta ratio of 3 to reduce the risk of late toxicities. QoL data was collected from patients at the time of consultation and at subsequent follow up appointments using the MD Anderson Dysphagia Inventory (MDADI) and Symptom Inventory (MDASI).Results: The 1- and 2- year rates of local, regional, and distant control and overall survival were 79/79, 74/70, 74/71, and 59/45%, respectively. Late grade 3 toxicities were seen in 3% in the group treated to the aerodigestive tract and 1% in the group treated to the skull base. No grade 4 or 5 toxicities were observed. Patients with skull base re-irradiation maintained a stable QoL score after radiation treatment, while patients treated to the aerodigestive tract demonstrated a slight impairment associated with worsening dysphagia, compared to their pretreatment baseline. All groups experienced an increase in xerostomia.Conclusions: OARExtreme-sparing SBRT is able to achieve excellent tumor coverage while protecting the organs at highest risk of re-irradiation-related complications. The potential for lower toxicities and maintained QoL with this treatment makes it a promising option for salvage of recurrent head and neck cancer.SummaryLocal control and overall survival rates for recurrent head and neck cancer remain poor, despite the use of local therapy. In addition, re-irradiation with conventional radiation therapy confers a high rate of grade 3 and higher late toxicities. SBRT appears to improve the therapeutic ratio in this patient population, and treatment planning with a focus on sparing OARExtreme may further decrease the rates of morbidity in these patients.
Highlights
Late grade 3 toxicities were seen in 3% in the group treated to the aerodigestive tract and 1% in the group treated to the skull base
Patients with skull base re-irradiation maintained a stable quality of life (QoL) score after radiation treatment, while patients treated to the aerodigestive tract demonstrated a slight impairment associated with worsening dysphagia, compared to their pretreatment baseline
Locoregional recurrence within a previously-irradiated field represents a significant barrier in the long-term control of head and neck cancer, with a high rate of morbidity and mortality associated with local disease
Summary
Locoregional recurrence within a previously-irradiated field represents a significant barrier in the long-term control of head and neck cancer, with a high rate of morbidity and mortality associated with local disease. Regardless, most patients are not surgical candidates due to their extent of tumor recurrence or other comorbidities limiting their ability to tolerate the operation [1]. Both chemotherapy and conventionally fractionated radiation therapy have been used for recurrent, unresectable disease, with a median survival ranging from 6 to 9 months, with rates of grade 3 and higher late toxicities approaching 40% [2, 3]. Stereotactic body radiation therapy (SBRT) has been increasingly used for irradiation of recurrent head and neck cancer, both in the definitive and adjuvant settings. Recent studies have demonstrated the relatively low rates of severe toxicities with SBRT in the re-irradiation setting, but without a substantial improvement in overall survival compared to conventionally fractionated radiation therapy [4,5,6]
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