Abstract
Reirradiation (reRT) for locoregional recurrences poses unique challenges and risks;
re-treatment using proton beam radiotherapy (PBT) could prove advantageous. Assessing
clinical outcomes and toxicity profiles, this systematic review comprehensively evaluated
available evidence regarding PBT reRT. Fourteen original investigations across central
nervous system (CNS) (n = 6), head/neck (H&N) (n = 4), lung (n = 2), and gastrointestinal (n = 2) malignancies were analyzed. PBT for recurrent uveal melanoma achieved 5-year eye
retention of 55%; for chordomas, reRT afforded a 2-year local control and overall
survival (OS) of 85% and 80%, respectively. Multiple PBT reRT studies for adult gliomas
illustrate no grade ≥3 toxicities. Two pediatric CNS tumor studies demonstrated the
safety and efficacy of reRT, with one total grade 3 toxicity and achievement of longer-term
OS. PBT for H&N malignancies shows appropriate local/locoregional control and favorable
toxicity profiles versus historical photon-based methods, including low (9–10%) rates
of feeding tube placement. PBT for recurrent lung cancer can achieve favorable survival
with expected toxicities/complications of reRT, especially with concurrent chemotherapy
and centrally located recurrences. Lastly, PBT reRT in gastrointestinal malignancies
induced very few high-grade complications. Hence, based on the limited existing data,
PBT is a notably safe reRT modality for effective salvage of recurrent disease. Institutional
experiences must continue to be reported: dosimetric correlations, late toxicities,
and advanced PBT techniques.
Keywords
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Article info
Publication history
Published online: September 20, 2017
Accepted:
August 6,
2017
Received in revised form:
August 6,
2017
Received:
March 29,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
