Intensity-Modulated Radiotherapy With Concurrent Chemotherapy for Previously Irradiated, Recurrent Head and Neck Cancer

Matthew C. Biagioli, Mark Harvey, Eloy Roman, Luis E. Raez, Aaron Wolfson, Subhakar Mutyala, Hyo S. Han, Arnold Markoe

Research output: Contribution to journalArticle

60 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1067-1073
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume69
Issue number4
DOIs
StatePublished - Nov 15 2007

Fingerprint

Intensity-Modulated Radiotherapy
chemotherapy
Head and Neck Neoplasms
radiation therapy
cancer
Drug Therapy
Salvage Therapy
therapy
toxicity
Disease-Free Survival
Radiotherapy
Therapeutics
Survival
Kaplan-Meier Estimate
Chemoradiotherapy
schedules
death
surgery
progressions
Survivors

Keywords

  • Chemotherapy
  • IMRT
  • Intensity-modulated radiotherapy
  • Radiotherapy
  • Recurrent head and neck cancer
  • Salvage therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Intensity-Modulated Radiotherapy With Concurrent Chemotherapy for Previously Irradiated, Recurrent Head and Neck Cancer. / Biagioli, Matthew C.; Harvey, Mark; Roman, Eloy; Raez, Luis E.; Wolfson, Aaron; Mutyala, Subhakar; Han, Hyo S.; Markoe, Arnold.

In: International Journal of Radiation Oncology Biology Physics, Vol. 69, No. 4, 15.11.2007, p. 1067-1073.

Research output: Contribution to journalArticle

Biagioli, Matthew C. ; Harvey, Mark ; Roman, Eloy ; Raez, Luis E. ; Wolfson, Aaron ; Mutyala, Subhakar ; Han, Hyo S. ; Markoe, Arnold. / Intensity-Modulated Radiotherapy With Concurrent Chemotherapy for Previously Irradiated, Recurrent Head and Neck Cancer. In: International Journal of Radiation Oncology Biology Physics. 2007 ; Vol. 69, No. 4. pp. 1067-1073.
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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.",
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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

AU - Mutyala, Subhakar

AU - Han, Hyo S.

AU - Markoe, Arnold

PY - 2007/11/15

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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.

AB - 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.

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KW - Recurrent head and neck cancer

KW - Salvage therapy

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