Reirradiation of Head and Neck Cancers with Proton Therapy: Outcomes and Analyses
Menée à partir de données portant sur 60 patients atteints d'un cancer de la tête et du cou traité par radiothérapie en combinaison ou non avec une chimiothérapie (durée médiane de suivi : 13,6 mois), cette étude évalue l'efficacité, du point de vue du contrôle locorégional de la maladie et des taux de survie à 1 an, et la toxicité d'une seconde irradiation par protonthérapie
Purpose : Reirradiation of the head and neck (H&N) cancer is a clinical challenge. Proton radiation therapy (PRT) offers dosimetric advantages for normal tissue sparing and may benefit previously irradiated patients. Here, we report our initial experience with the use of PRT for H&N reirradiation, with focus on clinical outcomes and toxicity. Methods and Materials : We retrospectively reviewed the records of patients who received H&N reirradiation using PRT from April 2011 through June 2015. Patients reirradiated with palliative intent or without prior documentation of H&N radiotherapy were excluded. Radiation-related toxicities were recorded per Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Results : Sixty (60) patients were evaluated, with a median follow-up of 13.6 months. Fifteen (25%) patients received passive scatter proton therapy (PSPT) and 45 (75 %) received intensity modulated proton therapy (IMPT). Thirty-five (58%) patients received upfront surgery, and 44 (73%) received concurrent chemotherapy. The 1-year LFFS, OS, PFS and DMFS rates were 68.4%, 83.8%, 60.1%, and 74.9%, respectively. Eighteen patients (30%) experienced acute grade 3 (G3) toxicities and 13 (22%) required a feeding tube at the end of PRT. The 1-year late G3 toxicity and feeding tube independence rates were 16.7% and 2.0%, respectively. There was 1 acute and 2 potential late G5 adverse events associated with reirradiation. Conclusions : Proton beam therapy as a curative reirradiation strategy is safe and efficacious, with an acceptable rate of toxicity and durable disease control.