2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Oral Oncology 73 (2017) 160–165

D.N. Margalit et al.

Table 1 (continued)

Table 1 Patient and treatment characteristics of 75 patients treated with reirradiation for re- current of second primary squamous cell cancer of the head and neck.

Characteristics

No. (%)

Oral cavity → oral cavity

7 (9) 7 (9) 5 (7) 4 (5) 4 (5) 4 (5)

Characteristics

No. (%)

Oral cavity → neck Oropharynx → neck

Gender - male

54 (72)

Oropharynx → larynx/hypopharynx Larynx/hypopharynx → oropharynx

Mean age at reirradiation

60.3 years (range, 26 – 91) 2.5 years (range, 0.2 – 26.4)

Median time interval since initial radiation

Larynx/hypopharynx → neck

Details of initial radiation therapy course Site Hypopharynx/larynx

Other

19 (25)

27 (36) 20 (27) 17 (23)

Key: CRT – chemoradiation; 5-FU – 5- fl uorouracil; Gy – Gray; no – number; RT – radiation therapy. † Stage provided for recurrences in order to provide details of extent of primary site and neck disease. Neck-only disease staged per N-stage (e.g. T0N1 = stage III).

Oropharynx Oral cavity Nasopharynx

5 (7) 4 (5) 2 (3)

Unknown primary

Neck-only

Stage

Table 2 Site of recurrence treated with salvage surgery prior to reirradiation among 75 patients treated for recurrent/second primary squamous cell cancer of the head and neck.

0 (Tis – larynx)

1 (1)

I

16 (21) 10 (13) 14 (19) 34 (45) 53 (71) 22 (29) 32 (43) 27 (36) 13 (17)

II

III IV

Anatomic Site

De fi nitive RT

Salvage surgery

Nasopharynx (n = 3)

Oral cavity (n = 12)

Oropharynx (n = 18)

Larynx/ hypopharynx (n = 23)

Neck- only (n = 19)

Adjuvant

RT technique Conformal

IMRT

Yes No

0 3

10

3

11 12

14

Laterals

2

15

5

Other

3 (4)

Median dose

70 Gy (range, 45 – 80 Gy) 2 Gy (range, 1 – 2.5 Gy)

Median dose per fraction

Survival outcomes

Chemotherapy None

38 (51) 19 (25) 16 (21)

With a median follow-up of 2.9 years for surviving patients (1.4 years for the entire cohort), there were 48 deaths with a median overall survival of 1.8 years after completion of reRT. The rate of re- currence was previously reported [10] . The 2-year cumulative in- cidence of isolated LRR was 22.5% (95% CI 13.6 – 32.7%). The 2-year cumulative incidence of concurrent LRR and DM was 19.6% (95% CI 11.3 – 29.5%), and isolated distant failure was 5.7% (95% CI 1.8 – 12.8%).

Concurrent

Induction → concurrent Induction → surgery → RT Details or reirradiation course Site – No. (%) Hypopharynx/larynx

2 (3)

23 (31) 19 (25) 18 (24) 12 (16)

Neck-only recurrence

Oropharynx Oral cavity Nasopharynx

3 (4)

Recurrent stage †

No. (%)

I

4 (5)

Toxicity outcomes

II

15 (20) 11 (15) 45 (60)

III IV

Overall, 39 (52%) patients had at least one serious toxicity as listed in Table 3 , with a median time to serious toxicity of 1.1 years. There were no acute grade 5 toxicities. The most common reason for hospi- talization was aspiration pneumonia (8 of 18 patients), symptom Table 3 Toxicity outcomes of 75 patients treated with reirradiation for recurrent of second pri- mary squamous cell cancer of the head and neck.

Total courses of RT (including reirradiation) – No. (%) 2

72 (96)

3

3 (4)

Reirradiation timing – No. (%) De fi nitive (no salvage surgery)

41 (55) 34 (45)

Adjuvant

Overall treatment plan at reirradiation – No. (%) Surgery → concurrent CRT

29 (39) 25 (33) 12 (16)

Concurrent CRT

Toxicity type

Induction chemotherapy → concurrent CRT

Surgery → RT

4 (5) 4(5) 1 (1)

Hospitalized during reirradiation

18 (24%) 13 (18%) 6.0 months 14 (19%)

RT-alone

Tracheotomy required after start of reirradiation Median time from re-RT end to tracheotomy Soft tissue complication requiring surgical intervention

Induction chemotherapy → surgery → RT

Median RT dose, Gy (range)

60 Gy (59.4 – 70 Gy) 2 Gy (1.2 – 2.0 Gy)

Median dose per fraction, Gy (range) Induction chemotherapy type – No. (%) Docetaxel/cisplatin/5-Fluorouracil

Fatal and non-fatal hemorrhage, total *

7 (9%)

Median time from re-RT end to hemorrhage

8.3 months

11

Fatal hemorrhage, total

4 (5%)

Paclitaxel/5-Fluorouracil Carboplatin/Paclitaxel

1 1

Fatal hemorrhage amongst patients NED ǂ

2 (2.7%)

Concurrent chemotherapy type – No. (%) Platinum/taxane

Acute grade 4 events (not already listed above) Dermatitis Cardiovascular (myocardial infarction) Acute grade 5 (within 3 months of treatment)

28 (37) 14 (19) 14 (19)

1 (1%) 1 (1%)

Platinum alone

Platinum/taxane/cetuximab

0

Platinum/cetuximab

8 (11)

Any of above

39 (52%)

None

6 (8)

Cetuximab 5 (7) Initial site at fi rst radiation course → site at reirradiation – No. (%) Larynx/hypopharynx → larynx/hypopharynx 17 (23) Oropharynx → oropharynx 8 (11)

RT – radiation therapy; NED – no evidence of disease. * Includes one patient who died at home after oropharyngeal bleeding. The sites of hemorrhage were based on the documented clinical assessment during hospitalization which was based on exam under anesthesia or cross-sectional imaging. ǂ Includes 1 patient with a total of 3 courses of head and neck radiation.

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