Re-Irradiation for Head and Neck Cancer: Cumulative Dose to Organs at Risk and Late Side Effects
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Toxicity
2.3. Organs at Risk
2.4. Dose Accumulation
2.5. Statistics
3. Results
3.1. Patient and Treatment Characteristics
3.2. Toxicity
3.3. Predictors of Toxicity
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Patient and Treatment Characteristics at First Presentation | Number | Percent (Range) |
---|---|---|
Male | 35 | 65 |
Female | 19 | 35 |
Median age (years) | 59 | (33 to 81) |
Tumor site | ||
Larynx | 6 | 11 |
Oropharyngeal * | 18 | 33 |
Nasopharyngeal | 1 | 2 |
Hypopharyngeal | 5 | 9 |
Oral cavity | 17 | 31 |
Unknown primary | 2 | 4 |
Sino/nasal | 3 | 6 |
Salivary gland | 2 | 4 |
Histology | ||
Squamous cell carcinoma | 46 | 85 |
Adenoid cystic carcinoma | 5 | 9 |
Other † | 3 | 6 |
Tumor Stage | ||
I | 5 | 9 |
II | 11 | 20 |
III | 7 | 13 |
IVa | 28 | 52 |
IVb | 3 | 6 |
T-stage | ||
0 | 2 | 4 |
1 | 9 | 17 |
2 | 22 | 41 |
3 | 4 | 7 |
4 | 17 | 31 |
Median treatment dose (Gy) | 68 | (60–79) |
Patient and Treatment Characteristics at Re-Irradiation | Number | Percent (Range) |
---|---|---|
Median age at end of re-irradiation (years) | 63 | (40 to 89) |
Median time between radiations (months) | 36 | (5 to 177) |
Performance status | ||
0 | 30 | 56 |
1 | 21 | 39 |
2 | 2 | 4 |
3 | 1 | 2 |
Tumor | ||
Local recurrence | 37 | 69 |
Secondary primary tumor | 17 | 31 |
Surgery before re-irradiation | ||
No | 32 | 59 |
Primary tumor | 11 | 20 |
Neck dissection | 8 | 15 |
Primary tumor and neck dissection | 3 | 6 |
Systemic medical treatment | ||
No | 41 | 76 |
Induction chemotherapy | 11 | 20 |
Concurrent chemotherapy (cisplatin) | 1 | 2 |
Concurrent cetuximab | 1 | 2 |
Radiotherapy technique at re-irradiation | ||
VMAT/IMRT | 45 | 83 |
VMAT/IMRT + brachytherapy | 3 | 6 |
3 D conformal | 4 | 7 |
3 D conformal + brachytherapy | 1 | 2 |
Brachytherapy | 1 | 2 |
Median re-irradiation dose (Gy) | 59 | (40 to 71) |
Median cumulative near max dose, D1cc (Gy) | 129 | (106 to 478) |
Median PTV at re-irradiation (cm³) | 145 | (13 to 668) |
Median re-treated volume, V100 (cm³) | 90 | (2 to 283) |
Appendix B
Appendix B.1. Reference Cohort
Appendix B.2. Comparison of morbidity to the Reference Cohort
References
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Subject | Late Side Effects Grade ≥3 at Two Years After Re-Irradiation |
---|---|
10 | None |
11 | Mucosa, Osteoradionecrosis |
13 | None |
19 | None |
26 | None |
27 | Skin, Mucosa, Xerostomia, Dysphagia |
35 | None |
37 | None |
42 | Xerostomia |
45 | None |
52 | Osteoradionecrosis, Trismus |
Subject | Tumor Site at First Presentation | Late Side Effects Grade ≥3 after Re-RT | Surgery at First Presentation | Surgery Before Re-RT | PS at Re-RT | Grade ≥3 side effect at 1 st RT | Time between RT and re-RT (months) | Age at Re-RT (years) | PTV at Re-RT (cm³) | V100 at Re-RT (cm³) | Concomitant Systemic Therapy at Re-RT | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Skin | Mucosa | Larynx | Salivary Glands | Dysphagia | ORN | Trismus | Blowout | Other | |||||||||||
52 | Sino/nasal | No | No | No | No | No | Grade 4 | Grade 3 | No | No | Primary tumor | No | 0 | No | 88 | 41 | 62 | 71 | No |
42 | Nasopharyngeal | No | No | No | Grade 3 | No | No | No | No | Grade 3 | No | No | 0 | No | 60 | 55 | 248 | 91 | No |
23 | Oral cavity | No | Grade 3 | No | No | No | No | No | No | No | Primary tumor | No | 1 | No | 73 | 69 | 262 | 119 | No |
27 | Oral cavity | Grade 3 | Grade 3 | No | Grade 3 | Grade 3 | No | No | No | No | Primary tumor | Primary tumor | 0 | No | 108 | 62 | 198 | 256 | No |
30 | Oral cavity | No | No | No | No | No | No | Grade 3 | No | No | No | No | 1 | No | 78 | 60 | 161 | 167 | No |
41 | Oral cavity | No | No | No | No | Grade 3 | No | No | No | No | Primary tumor + ND | No | 0 | Yes | 127 | 60 | 44 | 82 | No |
7 | Oropharyngeal † | No | Grade 3 | No | Grade 3 | Grade 3 | No | No | No | No | No | Primary tumor | 0 | No | 138 | 74 | 309 | 87 | No |
17 | Oropharyngeal † | No | No | No | No | No | No | Grade 3 | No | Grade 3 | No | No | 1 | Yes | 177 | 71 | 102 | 141 | No |
22 | Oropharyngeal * | No | No | No | No | Grade 4 | No | Grade 4 | No | No | No | No | 0 | No | 36 | 68 | 128 | 142 | No |
31 | Oropharyngeal * | Grade 3 | No | No | Grade 3 | Grade 3 | No | Grade 3 | No | No | No | Primary tumor | 0 | No | 50 | 61 | 333 | 120 | No |
37 | Oropharyngeal * | No | No | No | No | No | Grade 4 | No | No | No | No | Primary tumor | 0 | No | 136 | 59 | 219 | 154 | No |
38 | Oropharyngeal * | No | No | No | No | No | Grade 3 | No | Grade 5 | No | No | Primary tumor | 1 | No | 31 | 56 | 106 | 138 | No |
6 | Hypopharyngeal | No | Grade 4 | No | No | No | No | No | No | No | No | No | 0 | No | 43 | 74 | 93 | 64 | No |
20 | Hypopharyngeal | No | Grade 3 | No | No | No | No | No | No | No | No | No | 0 | Yes | 21 | 64 | 149 | 109 | No |
24 | Hypopharyngeal | No | No | No | No | Grade 3 | No | No | No | No | No | Primary tumor + ND | 0 | No | 71 | 64 | 26 | 56 | No |
9 | Larynx | No | No | No | No | No | No | No | Grade 5 | No | Primary tumor + ND | ND | 1 | No | 15 | 74 | 66 | 92 | No |
19 | Larynx | No | No | No | No | Grade 4 | No | No | No | No | No | Primary tumor + ND | 0 | No | 15 | 68 | 452 | 76 | No |
5 | Salivary gland | Grade 3 | No | No | No | No | No | No | No | No | Primary tumor + ND | No | 0 | No | 81 | 77 | 283 | 89 | No |
11 | Unknown primary | No | Grade 4 | No | No | No | Grade 3 | No | No | No | ND | Primary tumor | 0 | No | 149 | 76 | 154 | 166 | No |
Median (whole cohort) | 95% was PS 0–1 | 36 | 63 | 145 | 90 |
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Embring, A.; Onjukka, E.; Mercke, C.; Lax, I.; Berglund, A.; Bornedal, S.; Wennberg, B.; Dalqvist, E.; Friesland, S. Re-Irradiation for Head and Neck Cancer: Cumulative Dose to Organs at Risk and Late Side Effects. Cancers 2021, 13, 3173. https://doi.org/10.3390/cancers13133173
Embring A, Onjukka E, Mercke C, Lax I, Berglund A, Bornedal S, Wennberg B, Dalqvist E, Friesland S. Re-Irradiation for Head and Neck Cancer: Cumulative Dose to Organs at Risk and Late Side Effects. Cancers. 2021; 13(13):3173. https://doi.org/10.3390/cancers13133173
Chicago/Turabian StyleEmbring, Anna, Eva Onjukka, Claes Mercke, Ingmar Lax, Anders Berglund, Sara Bornedal, Berit Wennberg, Emmy Dalqvist, and Signe Friesland. 2021. "Re-Irradiation for Head and Neck Cancer: Cumulative Dose to Organs at Risk and Late Side Effects" Cancers 13, no. 13: 3173. https://doi.org/10.3390/cancers13133173