Intensity-modulated radiotherapy for recurrent and second primary head and neck cancer in previously irradiated territory

Duprez, Fréderic; Madani, Indira; Bonte, Katrien; Boterberg, Tom; Vakaet, Luc; Derie, Cristina; De Gersem, Werner; De Neve, Wilfried

doi:10.1016/j.radonc.2009.10.012

« Previous Next »Radiotherapy & Oncology
Volume 93, Issue 3 , Pages 563-569, December 2009

Intensity-modulated radiotherapy for recurrent and second primary head and neck cancer in previously irradiated territory☆

Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
- Corresponding author. Address: Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
Indira Madani
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
Katrien Bonte
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
Tom Boterberg
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
Luc Vakaet
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
Cristina Derie
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
Werner De Gersem
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
Wilfried De Neve
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium

Received 29 January 2009; received in revised form 13 October 2009; accepted 22 October 2009. published online 18 November 2009.

Abstract

Purpose

To evaluate re-irradiation using IMRT for recurrent and second primary head and neck cancer in previously irradiated territory.

Materials and methods

Between 1997 and 2008, 84 patients with recurrent and second primary head and neck cancer were treated with IMRT to a median dose of 69Gy. Median time interval between initial radiotherapy and re-irradiation was 49.5 (5.2–298.3) months. Salvage surgery preceded re-irradiation in 19 patients; 17 patients received concurrent chemotherapy.

Results

Median follow-up of living patients was 19.8 (1.9–76.1) months. Five-year locoregional control and overall survival were 40% and 20%, respectively. Five-year disease-specific survival and disease-free survival were 29% and 15%, respectively. Stage T4 (p=0.015), time interval between initial treatment and re-irradiation (p=0.011) and hypopharyngeal cancer (p=0.013) were independent prognostic factors for worse overall survival in multivariate analysis. Twenty-six and 11 patients developed Grade ⩾3 acute and late toxicity, respectively. No Grade 5 acute toxicity was encountered. There were 2 fatal vascular ruptures during follow-up.

Conclusions

High-dose IMRT for recurrent and second primary head and neck cancer in previously irradiated territory leads to ≈20% long-term survival in a non-selected patient population. Identification of patients who would benefit most of curative IMRT is warranted.

Keywords: Recurrent head and neck cancer, Second primary head and neck cancer, IMRT, Re-irradiation