Curative high-dose reirradiation for patients with recurrent head and neck adenoid cystic carcinomas: outcomes and analysis of patterns of failure.

IF 2.1 4区医学 Q2 BIOLOGY

International Journal of Radiation Biology Pub Date : 2024-01-01 Epub Date: 2023-08-21 DOI:10.1080/09553002.2023.2242934

Mathilde Mahé, Arnaud Beddok, Farid Goudjil, Catherine Ala Eddine, Stéphanie Bolle, Laurence Champion, Loïc Feuvret, Philippe Herman, Sofia Zefkili, Olivier Choussy, Christophe Le Tourneau, Remi Dendale, Irene Buvat, Elisabeth Sauvaget, Gilles Créhange, Valentin Calugaru

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引用次数: 1

Abstract

Background: To investigate the outcomes of patients who underwent curative reirradiation (reRT), with intensity-modulated radiation therapy (IMRT) or proton therapy (PT) for unresectable recurrent or second primary head and neck adenoid cystic carcinoma (HNACC).

Methods: Ten patients, mostly KPS 90%, were reirradiated (3/10 with IMRT and 7/10 with PT) at a median maximum dose to the CTV of 64.2 Gy from July 2011 to November 2021. Locations at the time of reRT were mainly the sinus (4/10) and the salivary glands (including the parotid and submandibular gland, 3/10). CTCAEv5 was used to assess acute and late toxicities. Follow-up was the time between the end of reRT and the date of last news.

Results: The median time between the two irradiations was 53.5 months (IQR: 18-84). After a median follow-up of 26 months (range, 12.5-51.8 months), six patients had developed a locoregional recurrence (LR), of which four occurred within the previously irradiated volume. Two and three-year locoregional failure-free survival (LFFS) and overall survival (OS) were 55.6% [95%CI: 31-99.7%], and 41% [18.5-94%] and 66.7% [42-100%] and 44.4% [21.4-92.3%], respectively. LFFS and OS were significantly better in the subgroup of sinus tumors (p = .013) and the subgroup of patients re-irradiated more than two years after the first course of irradiation (p = .01). Seven patients had impairments before the start of reRT, including hearing impairment (3/10) and facial nerve impairment (3/10). The most severe late toxicities were brain necrosis (2/10), osteoradionecrosis (1/10) and vision decreased (1/10).

Conclusion: Curative reRT for HNACC is possible for selected cases, but the LR rate in the irradiated field and the risk of severe toxicity remain high. Improved selection criteria and more carefully defined target volumes may improve outcome in these patients. A further study including larger cohort of patients would be useful to confirm these results.

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对复发性头颈部腺样囊性癌患者进行根治性大剂量再照射：疗效和失败模式分析。

研究背景目的：研究因无法切除的复发性或第二原发性头颈部腺样囊性癌（HNACC）而接受根治性再照射（reRT）、调强放射治疗（IMRT）或质子治疗（PT）的患者的疗效：2011年7月至2021年11月，10名患者接受了再放射治疗（3/10采用IMRT，7/10采用PT），CTV的中位最大剂量为64.2 Gy。再次照射的部位主要是鼻窦（4/10）和唾液腺（包括腮腺和颌下腺，3/10）。CTCAEv5用于评估急性和晚期毒性。随访时间为再照射结束至最后一次消息发布日期之间的时间：两次照射之间的中位时间为 53.5 个月（IQR：18-84）。中位随访26个月（12.5-51.8个月）后，6名患者出现了局部复发（LR），其中4例发生在之前接受过照射的区域。两年和三年的无局部失败生存率（LFFS）和总生存率（OS）分别为55.6% [95%CI：31-99.7%]和41% [18.5-94%]，以及66.7% [42-100%]和44.4% [21.4-92.3%]。窦状肿瘤亚组（p = .013）和首次照射后两年以上再次照射的患者亚组（p = .01）的LFFS和OS明显更好。有七名患者在开始再照射前就出现了功能障碍，包括听力障碍（3/10）和面神经障碍（3/10）。最严重的晚期毒性反应是脑坏死（2/10）、骨坏死（1/10）和视力下降（1/10）：结论：HNACC 的治愈性再放射治疗可用于部分病例，但照射野的 LR 率和严重毒性的风险仍然很高。改进选择标准和更仔细地界定靶区可能会改善这些患者的预后。包括更多患者在内的进一步研究将有助于证实这些结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Radiation Biology 医学-核科学技术

CiteScore

5.00

自引率

11.50%

发文量

142

审稿时长

3 months

期刊介绍： The International Journal of Radiation Biology publishes original papers, reviews, current topic articles, technical notes/reports, and meeting reports on the effects of ionizing, UV and visible radiation, accelerated particles, electromagnetic fields, ultrasound, heat and related modalities. The focus is on the biological effects of such radiations: from radiation chemistry to the spectrum of responses of living organisms and underlying mechanisms, including genetic abnormalities, repair phenomena, cell death, dose modifying agents and tissue responses. Application of basic studies to medical uses of radiation extends the coverage to practical problems such as physical and chemical adjuvants which improve the effectiveness of radiation in cancer therapy. Assessment of the hazards of low doses of radiation is also considered.