Evaluation of proton therapy reirradiation for patients with recurrent head and neck squamous cell carcinoma Journal Article
| Authors: | Lee, A.; Woods, R.; Mahfouz, A.; Kitpanit, S.; Cartano, O.; Mohamed, N.; Youssef, I.; Marqueen, K.; Sine, K.; Mah, D.; Neal, B.; Zakeri, K.; Kang, J. J.; Riaz, N.; Yu, Y.; McBride, S. M.; Chen, L. D.; Tsai, C. J.; Gelblum, D. Y.; Press, R. H.; Michel, L. S.; Sherman, E. J.; Pfister, D.; Dunn, L. A.; Ho, A. L.; Fetten, J.; Wong, R. J.; Boyle, J. O.; Singh, B.; Cracchiolo, J. R.; Ganly, I.; Cohen, M. A.; Lee, N. Y. |
| Article Title: | Evaluation of proton therapy reirradiation for patients with recurrent head and neck squamous cell carcinoma |
| Abstract: | Key Points: Question: What are the outcomes of patients receiving proton therapy reirradiation for head and neck squamous cell carcinoma (HNSCC)? Findings: This cohort study of 242 patients with HNSCC found 1-year local control of 71.8% and 1-year overall survival of 66.6% for those receiving fractionated reirradiation. The study found 79 potential grade 3, 4 grade 4, and 5 grade 5 late toxic effects. Meaning: These findings suggest that proton therapy reirradiation may be associated with improved survival for patients with HNSCC, but the toxic effects may be substantial. This cohort study of patients with head and neck squamous cell carcinoma examines the outcomes and toxic effects associated with proton therapy reirradiation for patients with head and neck squamous cell carcinoma. Importance: Use of proton therapy reirradiation (PT-ReRT) for head and neck cancer is increasing; however, reports are heterogenous and outcomes can be difficult to interpret. Objective: To evaluate outcomes and toxic effects following PT-ReRT in a uniform and consecutive cohort of patients with head and neck squamous cell carcinoma. Design, Setting, and Participants: This retrospective cohort study included patients with recurrent primary head and neck squamous cell carcinoma who were treated with PT-ReRT from January 1, 2013, to December 31, 2020, at a single institution. Patient, clinical, and treatment characteristics were obtained, and multidisciplinary review was performed to record and grade early and late toxic effects. Exposures: Proton therapy reirradiation. Main Outcomes and Measures: Follow-up was defined from the start of PT-ReRT. The Kaplan-Meier method was used for outcomes of interest, including local control (LC), locoregional control, distant metastatic control, progression-free survival, and overall survival (OS). Cox proportional hazards regression modeling was used to assess associations of covariates with OS. Results: A total of 242 patients (median [range] age, 63 [21-96] years; 183 [75.6%] male) were included. Of these patients, 231 (95.9%) had a Karnofsky performance status score of 70 or higher, and 145 (59.9%) had at least a 10–pack-year smoking history. Median (range) follow-up was 12.0 (5.8-26.0) months for all patients and 24.5 (13.8-37.8) months for living patients. A total of 206 patients (85.1%) had recurrent disease vs second primary or residual disease. The median (range) interval between radiation courses was 22 (1-669) months. Median PT-ReRT dose was 70 cobalt gray equivalents (CGE) for the fractionated cohort and 44.4 CGE for the quad shot cohort. For the fractionated cohort, the 1-year LC was 71.8% (95% CI, 62.8%-79.0%) and the 1-year OS was 66.6% (95% CI, 58.1%-73.8%). For the quad shot cohort, the 1-year LC was 61.6% (95% CI, 46.4%-73.6%) and the 1-year OS was 28.5% (95% CI, 19.4%-38.3%). Higher Karnofsky performance status scores (hazard ratio [HR], 0.50; 95% CI, 0.25-0.99; P =.046) and receipt of salvage surgery prior to PT-ReRT (HR, 0.57; 95% CI, 0.39-0.84; P =.005) were associated with improved OS, whereas receipt of quad shot (HR, 1.97; 95% CI, 1.36-2.86; P <.001) was associated with worse OS. There were a total of 73 grade 3 and 6 grade 4 early toxic effects. There were 79 potential grade 3, 4 grade 4, and 5 grade 5 late toxic effects. Conclusions and Relevance: The findings of this cohort study suggest that, compared with previous reports with photon-based reirradiation, patients are living longer with aggressive PT-ReRT; however, surviving patients remain at risk of early and late complications. |
| Journal Title: | JAMA Network Open |
| Volume: | 6 |
| Issue: | 1 |
| ISSN: | 2574-3805 |
| Publisher: | American Medical Association |
| Date Published: | 2023-01-23 |
| Start Page: | e2250607 |
| Language: | English |
| DOI: | 10.1001/jamanetworkopen.2022.50607 |
| PROVIDER: | EBSCOhost |
| PROVIDER: | cinahl |
| PMCID: | PMC9871797 |
| PUBMED: | 36689229 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Nancy Y. Lee -- PDF incorrectly assigned author Linda Chen the middle initial "D" --Source: Cinahl |
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