Release: July 29, 2000
Contact: Kenneth Satterfield
703-519-1563
[email protected]
In San Francisco (7/28-8/2)
415-284-8082
RE-IRRADIATION OF UNRESECTABLE RECURRENT HEAD AND NECK CANCER MAY HELP A SELECT NUMBER OF PATIENTS
San Francisco, CA -- Radiotherapy is often used in treating patients with head and neck cancer. Following treatment, recurrences from the initial cancer and development of new head and neck tumors is not uncommon. When these recurrences or new tumors occur in previously irradiated patients and they are not resectable, treatment options are limited. One treatment option that provides some patients with a chance at cure is re-irradiation. A new study examines how effective this treatment option is in providing local control and cure.
The author of the study, "Re-irradiation of Recurrent or New Primary Head and Neck Cancer," is Laura A. Dawson MD, Department of Radiation Oncology, University of Michigan Hospitals and Health System, Ann Arbor, MI. Her findings were presented before the 5th International Conference on Head and Neck Cancer, being held July 29 through August 2, at the San Francisco Marriott, San Francisco, CA. More than 1,500 leading head and neck surgeons from the United States and 46 nations will gather to hear the latest medical research in the diagnosis, treatment, and reconstruction associated with head and neck cancer. The medical conference is sponsored by the American Head and Neck Society, www.headandneckcancer.org.
Methodology: A review of radiation oncology database was conducted for the period, 1983 - 1999, and identified 62 patients who had received re-irradiation of head and neck recurrence or new primary tumor, classified as unresectable or with residual disease following surgery. Patients had to have a minimum cumulative planned radiation dose of 100 Gy and a minimum cumulative delivered dose of 70 Gy. Twenty were not included since their original radiation records were not available and/or the cumulative planned radiation dose was less than 100 Gy. Forty-two patients were deemed eligible for the study. A review of the data base found:
The first course of radiation: The median age was 55 (range of 12-84 years); 26 males and 16 females composed the study cohort. Six had nasopharyngeal cancer, 34 (81 percent) were diagnosed with other head and neck epithelial cancers and two others had non-epithelial cancers.
Re-irradiation: Re-irradiation was administered in three of the patients for a new primary tumor (seven percent). Recurrence was the reason for the treatment in the remaining 39 (93 percent) of patients.
Re-irradiation treatment intent: Re-irradiation was administered for curative purposes in 33 (79 percent) and nine (21 percent) for a palliative intent. Distant metastases were found in four patients; Thirty-six of the 42 patients completed their prescribed treatment, but 14 patients did not, primarily due to difficulty with treatment side effects. Re-irradiation was delivered using conformal radiation techniques to minimize the dose to normal structures.
Dosage: Median radiation dose at re-irradiation was 60 Gy; the median cumulative dose was 117 Gy. Surgical debulking occurred in 20 patients and 14 received concurrent chemotherapy with their radiation.
Results: The median potential follow-up was 60 months. The median overall survival was 12.7 months, with one and two year survival rates of 53% and 36%. The median time to local regional relapse was 5.1 months; the corresponding rate with surgical salvage was 7.8 months. Patients most likely to benefit from re-irradiation were those without distant metastases, treated with curative intent, with non-bulky disease, with either laryngeal or nasopharyngeal cancer.
Conclusions: Generally, the overall survival rate for this study cohort was deemed poor, and further efforts to improve outcomes are necessary. However, a subset of patients may be salvaged with high dose confromal re-irradiation.
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