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Clinical Management of Blood–Brain Barrier Disruptions after Active Raster-Scanned Carbon Ion Re-Radiotherapy in Patients with Recurrent Head-and-Neck Cancer

1
Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
2
Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
3
National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany
4
Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
5
Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
6
Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
7
Department of Otorhinolaryngology, University of Heidelberg, 69120 Heidelberg, Germany
8
German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ, 69120 Heidelberg, Germany
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(3), 383; https://doi.org/10.3390/cancers11030383
Received: 25 February 2019 / Revised: 13 March 2019 / Accepted: 14 March 2019 / Published: 19 March 2019
(This article belongs to the Special Issue Targeting Head and Neck Cancer)
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Abstract

Purpose: The aim of the current evaluation was to assess central nervous system necrosis (CNSN) after re-irradiation with carbon ions (CR) in two-hundred seventeen (n = 217) patients with recurrent head-and-neck cancer (HNC). Methods: Thirty-six (n = 36) patients with CNSN were assessed retrospectively regarding clinical symptoms and radiographic response. Results: CNSN were classified according to clinical management in line with the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. At a median follow-up of 25.3 months (range 3.3–79.9 months), the median time interval until occurrence of grade I, II, and III CNSN was 9.2 months (range 2.8–75.0 months), 10.2 months (range 2.3–60.5 months), and 16.6 months (range 8.7–32.5 months), respectively. In one patient with an adenocarcinoma infiltrating the frontal lobe, an extensive CNSN grade IV was suspected but the patient declined surgical intervention. Radiographic response after treatment of CNSN grade I, II, and III, defined as ≥25% reduction of the T2 alteration on Magnetic Resonance Imaging (MRI), was observed in 4 (16.0%), 5 (29.4%), and 4 (80%) patients, respectively. Conclusion: CNSN occurred late and frequent after re-irradiation with carbon ions in patients with HNC infiltrating the base of skull. The clinical outcome with adequate treatment was encouraging but correct diagnosis of CNSN remains challenging. View Full-Text
Keywords: brain necrosis; carbon ions; particle therapy; head and neck cancer; re-irradiation brain necrosis; carbon ions; particle therapy; head and neck cancer; re-irradiation
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Held, T.; Akbaba, S.; Lang, K.; Harrabi, S.; Bernhardt, D.; Freudlsperger, C.; Kargus, S.; Plinkert, P.; Rieken, S.; Herfarth, K.; Debus, J.; Adeberg, S. Clinical Management of Blood–Brain Barrier Disruptions after Active Raster-Scanned Carbon Ion Re-Radiotherapy in Patients with Recurrent Head-and-Neck Cancer. Cancers 2019, 11, 383.

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