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Reirradiation for recurrent head and neck cancers using charged particle or photon radiotherapy

Erneute Bestrahlung von wiederkehrenden Kopf-Hals-Tumoren mittels Ionen- oder Photonenstrahlentherapie

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Abstract

Objective

To examine the outcomes of reirradiation for recurrent head and neck cancers using different modalities.

Methods

This retrospective study included 26 patients who received charged particle radiotherapy (CP) and 150 who received photon radiotherapy (117 CyberKnife radiotherapy [CK] and 36 intensity-modulated radiotherapy [IMRT]). Inverse probability of treatment weighting (IPTW) involving propensity scores was used to reduce background selection bias.

Results

Higher prescribed doses were used in CP than photon radiotherapy. The 1‑year overall survival (OS) rates were 67.9% for CP and 54.1% for photon radiotherapy (p = 0.15; 55% for CK and 51% for IMRT). In multivariate Cox regression, the significant prognostic factors for better survival were nasopharyngeal cancer, higher prescribed dose, and lower tumor volume. IPTW showed a statistically significant difference between CP and photon radiotherapy (p = 0.04). The local control rates for patients treated with CP and photon radiotherapy at 1 year were 66.9% (range 46.3–87.5%) and 67.1% (range 58.3–75.9%), respectively. A total of 48 patients (27%) experienced toxicity grade ≥3 (24% in the photon radiotherapy group and 46% in the CP group), including 17 patients with grade 5 toxicity. Multivariate analysis revealed that younger age and a larger planning target volume (PTV) were significant risk factors for grade 3 or worse toxicity.

Conclusion

CP provided superior survival outcome compared to photon radiotherapy. Tumor volume, primary site (nasopharyngeal), and prescribed dose were identified as survival factors. Younger patients with a larger PTV experienced toxicity grade ≥3.

Zusammenfassung

Zielsetzung

Bestimmung der Ergebnisse einer Rebestrahlung von wiederkehrenden Kopf-Hals-Tumoren mittels verschiedener Modalitäten.

Methode

Die retrospektive Studie umfasst 26 Patienten, die mit der Ionenstrahlentherapie (CP), und 150 Patienten, die mit der Photonenstrahlentherapie (117 Stereotaxien [CK] und 36 intensitätsmodulierte Strahlentherapien [IMRT]) behandelt wurden. Der Kehrwert der Behandlungswahrscheinlichkeit (IPTW) wurde für die Propensity-Score-Analyse angewendet, um die Hintergrundauswahleffekte zu verringern.

Ergebnisse

CP verwendete eine höhere verschriebene Dosierung als die Photonenstrahlentherapie. Die Gesamtüberlebensrate (OS) nach 1 Jahr betrug 67,9 % für CP und 54,1 % für die Photonenstrahlentherapie (p = 0,15; 55 % für CK und 51 % für IMRT). Maßgebliche Prognosefaktoren für das Überleben waren in der multivariaten Cox-Regression Nasen- und Kehlkopfkrebs, eine höhere verschriebene Dosierung und kleineres Tumorvolumen. Die IPTW zeigte einen statistisch signifikanten Unterschied zwischen der Ionen- oder Photonenstrahlentherapie (p = 0,04). Die lokalen Kontrollraten für Patienten, die mit der Ionen- oder Photonenstrahlentherapie behandelt wurden, betrugen nach 1 Jahr jeweils 66,9 % (Spanne 46,3–87,5 %) bzw. 67,1 % (Spanne 58,3–75,9 %). Insgesamt 48 Patienten (27 %) erfuhren eine Toxizität ≥ Grad 3 (24 % in der Photonenstrahlentherapie-, 46 % in der CP-Gruppe), einschließlich 17 Patienten mit einer Grad-5-Toxizität. In der multivariaten Analyse waren jüngeres Alter und größeres Planungszielvolumen (PTV) signifikante Risikofaktoren für eine Grad-3-Toxizität oder schlechter.

Schlussfolgerung

CP lieferte bessere Überlebensdaten als die Photonenstrahlentherapie. Tumorvolumen, Lage des Primärtumors (nasopharyngeal) und verschriebene Dosierung wurden als Überlebensfaktoren identifiziert. Jüngere Patienten mit größerem PTV erfuhren einen Toxizitätsgrad ≥3.

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Acknowledgements

The authors would like to thank Enago for the English language review and Crimson Interactive for German language review.

Author information

Authors and Affiliations

  1. Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, 602-8566, Kamigyo-ku, Kyoto, Japan

    Hideya Yamazaki MD, Satoaki Nakamura MD & Gen Suzuki MD

  2. CyberKnife Center, Soseikai General Hospital, 126 Kami-Misu, Shimotoba Fushimi-ku, Kyoto, Japan

    Hideya Yamazaki MD

  3. Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, 679-5165, Tatsuno, Hyogo, Japan

    Yusuke Demizu MD & Tomoaki Okimoto MD

  4. Radiotherapy Department, Fujimoto Hayasuzu Hospital, Hayasuzu 17-1, 885-0055, Miyakonojo, Miyazaki, Japan

    Mikio Ogita MD

  5. Department of Radiology, Japanese Red Cross Okayama Hospital, Aoe 2‑1-1, Kita-ku, 700-8607, Okayama, Okayama, Japan

    Kengo Himei MD

  6. Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, 540-0006, Osaka, Osaka, Japan

    Ken Yoshida MD & Tadayuki Kotsuma MD

  7. Department of Radiation Oncology, Osaka University Graduate School of Medicine, 565-0871, Suita, Osaka, Japan

    Yasuo Yoshioka MD

  8. Miyakojima IGRT Clinic, 534-0021, Osaka, Japan

    Ryoongjin Oh MD

Authors
  1. Hideya Yamazaki MD
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  2. Yusuke Demizu MD
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  3. Tomoaki Okimoto MD
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  7. Gen Suzuki MD
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  8. Ken Yoshida MD
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  10. Yasuo Yoshioka MD
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  11. Ryoongjin Oh MD
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Corresponding author

Correspondence to Hideya Yamazaki MD.

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Conflict of interest

H. Yamazaki, Y. Demizu, T. Okimoto, M. Ogita, K. Himei, S. Nakamura, G. Suzuki, K. Yoshida, T. Kotsuma, Y. Yoshioka, and R. Oh declare that they have no competing interests.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Yamazaki, H., Demizu, Y., Okimoto, T. et al. Reirradiation for recurrent head and neck cancers using charged particle or photon radiotherapy. Strahlenther Onkol 193, 525–533 (2017). https://doi.org/10.1007/s00066-017-1129-6

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  • DOI: https://doi.org/10.1007/s00066-017-1129-6

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