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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 1/2016

01-01-2016 | Original Article

Hyperfractionated stereotactic reirradiation for recurrent head and neck cancer

Authors: Jakub Cvek, M.D., PH.D., Lukas Knybel, M.S., Eva Skacelikova, M.D., Jiri Stransky, M.D., PH.D., Petr Matousek, M.D., PH.D., Karol Zelenik, M.D., PH.D., Oldrich Res, M.D., Bretislav Otahal, M.S., Lukas Molenda, M.S., David Feltl, M.D., PH.D, MBA

Published in: Strahlentherapie und Onkologie | Issue 1/2016

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Abstract

Purpose

The goal of this work was to evaluate the efficacy and toxicity of hyperfractionated stereotactic reirradiation (re-RT) as a treatment for inoperable, recurrent, or second primary head and neck squamous cell cancer (HNSCC) that is not suitable for systemic treatment.

Patients and materials

Forty patients with recurrent or second primary HNSCC were included in this study. The patients had a median gross tumor volume of 76 ml (range 14–193 ml) and a previous radiotherapy dose greater than 60 Gy. Treatment was designed to cover 95 % of the planning target volume (PTV, defined as gross tumor volume [GTV] + 3 mm to account for microscopic spreading, with no additional set-up margin) with the prescribed dose (48 Gy in 16 fractions b.i.d.). Treatment was administered twice daily with a minimum 6 h gap. Uninvolved lymph nodes were not irradiated.

Results

Treatment was completed as planned for all patients (with median duration of 11 days, range 9–14 days). Acute toxicity was evaluated using the RTOG/EORTC scale. A 37 % incidence of grade 3 mucositis was observed, with recovery time of ≤ 4 weeks for all of these patients. Acute skin toxicity was never observed to be higher than grade 2. Late toxicity was also evaluated according to the RTOG/EORTC scale. Mandible radionecrosis was seen in 4 cases (10 %); however, neither carotid blowout syndrome nor other grade 4 late toxicity occurred. One-year overall survival (OS) and local progression-free survival (L-PFS) were found to be 33 and 44 %, respectively. Performance status and GTV proved to be significant prognostic factors regarding local control and survival.

Conclusion

Hyperfractionated stereotactic re-RT is a reasonable treatment option for patients with recurrent/second primary HNSCC who were previously exposed to high-dose irradiation and who are not candidates for systemic treatment or hypofractionation.
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Metadata
Title
Hyperfractionated stereotactic reirradiation for recurrent head and neck cancer
Authors
Jakub Cvek, M.D., PH.D.
Lukas Knybel, M.S.
Eva Skacelikova, M.D.
Jiri Stransky, M.D., PH.D.
Petr Matousek, M.D., PH.D.
Karol Zelenik, M.D., PH.D.
Oldrich Res, M.D.
Bretislav Otahal, M.S.
Lukas Molenda, M.S.
David Feltl, M.D., PH.D, MBA
Publication date
01-01-2016
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 1/2016
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-015-0886-3

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