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Intensity-modulated radiotherapy with concurrent chemotherapy for previously irradiated, recurrent head and neck cancer.
Int J Radiat Oncol Biol Phys. 2007 Nov 15; 69(4):1067-73.IJ

Abstract

PURPOSE

Primary treatment fails in >70% of locally advanced head and neck cancer patients. Salvage therapy has a 30-40% response rate, but few long-term survivors. Intensity-modulated radiotherapy (IMRT) has recently emerged as a new modality for salvage therapy. This retrospective study evaluated our experience using every-other-week IMRT with concurrent chemotherapy.

METHODS AND MATERIALS

Between 2001 and 2006, 41 patients underwent IMRT as repeat RT with concurrent chemotherapy. All but 6 patients received 60 Gy at 2 Gy/fraction. RT was delivered on an alternating week schedule.

RESULTS

With a median follow-up time of 14 months, the overall response rate was 75.6%, with a complete response and partial response rate of 58.5% and 17.1%, respectively. The Kaplan-Meier estimate of overall survival, disease-free survival, and progression-free survival at 24 months was 48.7%, 48.1%, and 38%, respectively. Patients who underwent surgery as a part of their salvage therapy had a mean estimated survival of 30.9 months compared with 22.8 months for patients who received only chemoradiotherapy (p = 0.126). Grade 3 or 4 acute toxicities occurred in 31.7% of patients, but all had resolved within 2 months of therapy completion. No deaths occurred during treatment, except for 1 patient, who died shortly after discontinuing treatment early because of previously undiagnosed metastatic disease; 6 patients had long-term complications.

CONCLUSIONS

Concurrent chemotherapy with repeat radiotherapy with IMRT given every other week appears to be both well tolerated and feasible in patients treated with previous radiotherapy for recurrent head and neck cancer. IMRT represents a reasonable modality for reducing treatment-related toxicities in a repeat RT setting.

Authors+Show Affiliations

Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA. MCBiagioli@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

17967302

Citation

Biagioli, Matthew C., et al. "Intensity-modulated Radiotherapy With Concurrent Chemotherapy for Previously Irradiated, Recurrent Head and Neck Cancer." International Journal of Radiation Oncology, Biology, Physics, vol. 69, no. 4, 2007, pp. 1067-73.
Biagioli MC, Harvey M, Roman E, et al. Intensity-modulated radiotherapy with concurrent chemotherapy for previously irradiated, recurrent head and neck cancer. Int J Radiat Oncol Biol Phys. 2007;69(4):1067-73.
Biagioli, M. C., Harvey, M., Roman, E., Raez, L. E., Wolfson, A. H., Mutyala, S., Han, H. S., & Markoe, A. (2007). Intensity-modulated radiotherapy with concurrent chemotherapy for previously irradiated, recurrent head and neck cancer. International Journal of Radiation Oncology, Biology, Physics, 69(4), 1067-73.
Biagioli MC, et al. Intensity-modulated Radiotherapy With Concurrent Chemotherapy for Previously Irradiated, Recurrent Head and Neck Cancer. Int J Radiat Oncol Biol Phys. 2007 Nov 15;69(4):1067-73. PubMed PMID: 17967302.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensity-modulated radiotherapy with concurrent chemotherapy for previously irradiated, recurrent head and neck cancer. AU - Biagioli,Matthew C, AU - Harvey,Mark, AU - Roman,Eloy, AU - Raez,Luis E, AU - Wolfson,Aaron H, AU - Mutyala,Subhakar, AU - Han,Hyo S, AU - Markoe,Arnold, PY - 2007/04/02/received PY - 2007/04/30/accepted PY - 2007/10/31/pubmed PY - 2007/12/14/medline PY - 2007/10/31/entrez SP - 1067 EP - 73 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 69 IS - 4 N2 - PURPOSE: Primary treatment fails in >70% of locally advanced head and neck cancer patients. Salvage therapy has a 30-40% response rate, but few long-term survivors. Intensity-modulated radiotherapy (IMRT) has recently emerged as a new modality for salvage therapy. This retrospective study evaluated our experience using every-other-week IMRT with concurrent chemotherapy. METHODS AND MATERIALS: Between 2001 and 2006, 41 patients underwent IMRT as repeat RT with concurrent chemotherapy. All but 6 patients received 60 Gy at 2 Gy/fraction. RT was delivered on an alternating week schedule. RESULTS: With a median follow-up time of 14 months, the overall response rate was 75.6%, with a complete response and partial response rate of 58.5% and 17.1%, respectively. The Kaplan-Meier estimate of overall survival, disease-free survival, and progression-free survival at 24 months was 48.7%, 48.1%, and 38%, respectively. Patients who underwent surgery as a part of their salvage therapy had a mean estimated survival of 30.9 months compared with 22.8 months for patients who received only chemoradiotherapy (p = 0.126). Grade 3 or 4 acute toxicities occurred in 31.7% of patients, but all had resolved within 2 months of therapy completion. No deaths occurred during treatment, except for 1 patient, who died shortly after discontinuing treatment early because of previously undiagnosed metastatic disease; 6 patients had long-term complications. CONCLUSIONS: Concurrent chemotherapy with repeat radiotherapy with IMRT given every other week appears to be both well tolerated and feasible in patients treated with previous radiotherapy for recurrent head and neck cancer. IMRT represents a reasonable modality for reducing treatment-related toxicities in a repeat RT setting. SN - 0360-3016 UR - https://www.unboundmedicine.com/medline/citation/17967302/Intensity_modulated_radiotherapy_with_concurrent_chemotherapy_for_previously_irradiated_recurrent_head_and_neck_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(07)00816-4 DB - PRIME DP - Unbound Medicine ER -