Abstract:
OBJECTIVE:To identify predictive factors of severe long-term toxicity after re-irradiation of recurrent/persistent or second-primary head and neck cancer. METHODS:Outcomes and treatment plans of patients who underwent modern IMRT based re-irradiation to the head and neck from 2008-2015 were reviewed. Co-variables including demographic, clinical and oncologic factors, as well as interval to re-irradiation and re-irradiated planning tumor volume (PTV) were analyzed as predictors of developing severe (CTCAE grade⩾3) long-term toxicity with death as a competing risk. RESULTS:A total of 66 patients who met inclusion criteria were eligible for analysis. A median re-irradiation dose of 70Gy was delivered at a median of 37.5months after initial radiotherapy. Re-irradiation followed surgical resection in 25 (38%) patients, and concurrent chemotherapy was delivered to 41 (62%) patients. Median follow-up after re-irradiation was 23months and median overall survival was 22months (predicted 2year overall survival 49%). Of the 60 patients who survived longer than 3months after re-irradiation, 16 (25%) patients experienced severe long-term toxicity, with the majority (12 of 16) being feeding tube -dependent dysphagia. In multivariable analysis, shorter intervals to re-irradiation (<20months) and larger re-irradiated PTVs (>100cm(3)) were independent predictors of developing severe long-term toxicity. Patients with longer disease-free intervals and smaller PTVs had a 94% probability of being free of severe toxicity at two years. CONCLUSION:Selection of patients with longer re-irradiation intervals and requiring smaller re-irradiated PTVs can independently predict avoidance of severe long-term toxicity.
journal_name
Oral Oncoljournal_title
Oral oncologyauthors
Lee JY,Suresh K,Nguyen R,Sapir E,Dow JS,Arnould GS,Worden FP,Spector ME,Prince ME,McLean SA,Shuman AG,Malloy KM,Casper K,Bradford CR,Schipper MJ,Eisbruch Adoi
10.1016/j.oraloncology.2016.06.017subject
Has Abstractpub_date
2016-09-01 00:00:00pages
32-40eissn
1368-8375issn
1879-0593pii
S1368-8375(16)30091-4journal_volume
60pub_type
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