Salvage Carbon-Ion Radiation Therapy For Locoregionally Recurrent Head and Neck Malignancies

Jing Gao,Weixu Hu,Jiyi Hu,Xiyin Guan,Jing Yang,Lin Kong,Jiade J. Lu

doi:10.1038/s41598-019-39241-y

Abstract

To investigate the safety and efficacy of salvage carbon-ion radiation therapy (CIRT) in patients with locoregionally recurrent head and neck malignancies. One hundred and forty-one patients with locally recurrent head and neck malignancies previously treated with radiotherapy were salvaged using intensity-modulated carbon-ion radiation therapy (CIRT). The median dose was 60 Gray-Equivalent (GyE) (range 50–69 GyE, 2.0~3.5 GyE/daily fraction). All patients completed planned CIRT except for one. With a median follow-up time of 14.7 (range 1.6–36.4) months, the 1-year overall survival rate was 95.9%. Local, regional, and distant progression free survival rates were 84.9% and 97.7%, and 96%, respectively. Grade 3 or higher acute and late toxicities were observed in 7.1% of the patients. Ten patients developed mucosal necrosis and 4 of these patients deceased. Due to its physical and biological characteristics, CIRT appeared to be an acceptable treatment option for patients with locoregionally recurrent head and neck malignancies after previous radiotherapy. Treatment-induced adverse effects and early response to CIRT were both favorable. Longer follow-up is needed to evaluate the long-term outcome in terms of disease control, survival, as well as potential late effects.

Highlights

Charged particles such as proton or carbon-ion have a finite range and a distant Bragg peak[5]
The aim of this report is to address the early experience in terms of efficacy and toxicity of a relatively large group of patients with locally or locoregionally recurrent head and neck malignancies treated with carbon-ion radiation therapy (CIRT) using raster-scanning technology
This is an observational study and no experiment using human or animal sample(s) was involved. Patients in this cohort were treated according to our institutional research protocols that were approved by the institutional review board (IRB) of the Shanghai Proton and Heavy Ion Center (SPHIC)

Summary

Introduction

Charged particles such as proton or carbon-ion have a finite range and a distant Bragg peak[5]. Dosimetry studies have demonstrated that carbon-ion radiation therapy (CIRT) is more precise in the delivery of high-dose radiation to the target volume(s) while sparing OARs as compared to IMRT, thereby enhancing the therapeutic ratio over IMRT in head and neck cancer[6]. It is reasonable to postulate that this highly precise and biologically effective radiation technique is more effective when used to salvage locally recurrent head and neck malignancies that failed a prior course of high-dose radiation therapy in terms of improved disease control and toxicity profile as compared to IMRT. The aim of this report is to address the early experience in terms of efficacy and toxicity of a relatively large group of patients with locally or locoregionally recurrent head and neck malignancies treated with CIRT using raster-scanning technology

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