Intensity-Modulated Radiotherapy-Based Reirradiation for Head and Neck Cancer: A Multi-institutional Study by Korean Radiation Oncology Group (KROG 1707)

• Published in: Cancer research and treatment 2020, 52(4), , pp.1031-1040
• Main Authors: Lee, Jeongshim, Kim, Tae Hyung, Kim, Yeon-Sil, Kim, Myungsoo, Park, Jae Won, Kim, Sung Hyun, Kim, Hyun Ju, Lee, Chang Geol
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Chemoradiotherapy, Adjuvant - methods; Dose Fractionation, Radiation; Female; Follow-Up Studies; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasms, Second Primary - diagnosis; Neoplasms, Second Primary - mortality; Neoplasms, Second Primary - pathology; Neoplasms, Second Primary - therapy; Original; Prognosis; Radiotherapy, Intensity-Modulated - methods; Re-Irradiation - methods; Republic of Korea - epidemiology; Retrospective Studies; Salvage Therapy - methods; Treatment Outcome; Young Adult; 의학일반
• ISSN: 1598-2998; 2005-9256
• DOI: 10.4143/crt.2020.310

The benefits of reirradiation for head and neck cancer (HNC) have not been determined. This study evaluated the efficacy of reirradiation using intensity-modulated radiotherapy (IMRT) for recurrent or second primary HNC (RSPHNC) and identified subgroups for whom reirradiation for RSPHNC is beneficial. A total of 118 patients from seven Korean institutions with RSPHNC who underwent IMRT-based reirradiation between 2006 and 2015 were evaluated through retrospective review of medical records. We assessed overall survival (OS) and local control (LC) within the radiotherapy (RT) field following IMRT-based reirradiation. Additionally, the OS curve according to the recursive partitioning analysis (RPA) suggested by the Multi-Institution Reirradiation (MIRI) Collaborative was determined. At a median follow-up period of 18.5 months, OS at 2 years was 43.1%. In multivariate analysis, primary subsite, recurrent tumor size, interval between RT courses, and salvage surgery were associated with OS. With regard to the MIRI RPA model, the class I subgroup had a significantly higher OS than class II or III subgroups. LC at 2 years was 53.5%. Multivariate analyses revealed that both intervals between RT courses and salvage surgery were prognostic factors affecting LC. Grade 3 or more toxicity and grade 5 toxicity rates were 8.5% and 0.8%, respectively. IMRT-based reirradiation was an effective therapeutic option for patients with RSPHNC, especially those with resectable tumors and a long interval between RT courses. Further, our patients' population validated the MIRI RPA classification by showing the difference of OS according to MIRI RPA class.