Volume, dose, and fractionation considerations for IMRT-based reirradiation in head and neck cancer: A multi-institution analysis Journal Article
| Authors: | Caudell, J. J.; Ward, M. C.; Riaz, N.; Zakem, S. J.; Awan, M. J.; Dunlap, N. E.; Isrow, D.; Hassanzadeh, C.; Vargo, J. A.; Heron, D. E.; Marcrom, S.; Boggs, D. H.; Reddy, C. A.; Dault, J.; Bonner, J. A.; Higgins, K. A.; Beitler, J. J.; Koyfman, S. A.; Machtay, M.; Yao, M.; Trotti, A. M.; Siddiqui, F.; Lee, N. Y.; on behalf of the Multi-Institution Reirradiation (MIRI) Collaborative |
| Article Title: | Volume, dose, and fractionation considerations for IMRT-based reirradiation in head and neck cancer: A multi-institution analysis |
| Abstract: | Purpose: Limited data exist to guide the treatment technique for reirradiation of recurrent or second primary squamous carcinoma of the head and neck. We performed a multi-institution retrospective cohort study to investigate the effect of the elective treatment volume, dose, and fractionation on outcomes and toxicity. Methods and Materials: Patients with recurrent or second primary squamous carcinoma originating in a previously irradiated field (≥40 Gy) who had undergone reirradiation with intensity modulated radiation therapy (IMRT); (≥40 Gy re-IMRT) were included. The effect of elective nodal treatment, dose, and fractionation on overall survival (OS), locoregional control, and acute and late toxicity were assessed. The Kaplan-Meier and Gray's competing risks methods were used for actuarial endpoints. Results: From 8 institutions, 505 patients were included in the present updated analysis. The elective neck was not treated in 56.4% of patients. The median dose of re-IMRT was 60 Gy (range 39.6-79.2). Hyperfractionation was used in 20.2%. Systemic therapy was integrated for 77.4% of patients. Elective nodal radiation therapy did not appear to decrease the risk of locoregional failure (LRF) or improve the OS rate. Doses of ≥66 Gy were associated with improvements in both LRF and OS in the definitive re-IMRT setting. However, dose did not obviously affect LRF or OS in the postoperative re-IMRT setting. Hyperfractionation was not associated with improved LRF or OS. The rate of acute grade ≥3 toxicity was 22.1% overall. On multivariable logistic regression, elective neck irradiation was associated with increased acute toxicity in the postoperative setting. The rate of overall late grade ≥3 toxicity was 16.7%, with patients treated postoperatively with hyperfractionation experiencing the highest rates. Conclusions: Doses of ≥66 Gy might be associated with improved outcomes in high-performance patients undergoing definitive re-IMRT. Postoperatively, doses of 50 to 66 Gy appear adequate after removal of gross disease. Hyperfractionation and elective neck irradiation were not associated with an obvious benefit and might increase toxicity. © 2017 Elsevier Inc. |
| Keywords: | adult; treatment outcome; treatment failure; major clinical study; overall survival; intensity modulated radiation therapy; radiation dose; radiotherapy; cohort analysis; patient monitoring; retrospective study; radiation dose fractionation; multicenter study; irradiation; radiation hazard; cancer control; toxicity; locoregional control; intensity-modulated radiation therapy; wart virus; head-and-neck cancer; head and neck squamous cell carcinoma; re-irradiation; treatment techniques; squamous carcinoma; logistic regressions; methods and materials; human; male; female; priority journal; article; hyperfractionation |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 100 |
| Issue: | 3 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2018-03-01 |
| Start Page: | 606 |
| End Page: | 617 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2017.11.036 |
| PROVIDER: | scopus |
| PUBMED: | 29413274 |
| PMCID: | PMC7269162 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 May 2018 -- Source: Scopus |
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