Adjuvant Reirradiation With Proton Therapy in Head and Neck Squamous Cell Carcinoma.

Autor:	Hsieh K; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York., Hotca AE; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York., Dickstein DR; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York., Lehrer EJ; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York., Hsieh C; Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island., Gupta V; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York., Sindhu KK; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York., Liu JT; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York., Reed SH; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York., Chhabra A; New York Proton Center, New York, New York., Misiukiewicz K; Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York., Roof S; Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York., Kahn MN; Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York., Kirke D; Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York., Urken M; Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York., Posner M; Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York., Genden E; Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York., Bakst RL; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Jazyk:	angličtina
Zdroj:	Advances in radiation oncology [Adv Radiat Oncol] 2023 Dec 10; Vol. 9 (4), pp. 101418. Date of Electronic Publication: 2023 Dec 10 (Print Publication: 2024).
DOI:	10.1016/j.adro.2023.101418
Abstrakt:	Purpose: For patients with head and neck squamous cell carcinoma (HNSCC), locoregional failure and second primary tumors are common indications for adjuvant reirradiation (re-RT). Given an absence of clear consensus on the role of adjuvant re-RT, we sought to assess histopathologic risk factors of patients with HNSCC and their resulting outcomes after adjuvant re-RT with proton therapy. Methods and Materials: We conducted a retrospective analysis of patients with HNSCC who underwent salvage surgery at our institution followed by adjuvant re-RT with proton therapy over 1.5 years. All included patients received prior radiation therapy. The Kaplan-Meier method was used to evaluate locoregional recurrence-free survival and overall survival. Results: The cohort included 22 patients, with disease subsites, including oropharynx, oral cavity, hypopharynx, larynx, and nasopharynx. Depending on adverse pathologic features, adjuvant re-RT to 66 Gy (32% of cohort) or 60 Gy (68%), with (59%) or without (41%) concurrent systemic therapy was administered. The majority (86%) completed re-RT with no reported treatment delay; 3 patients experienced grade ≥3 acute Common Terminology Criteria for Adverse Events toxicity and no patient required enteral feeding tube placement during re-RT. Median follow-up was 21.0 months (IQR, 11.7-25.2 months). Five patients had biopsy-proven disease recurrences a median of 5.9 months (IQR, 3.8-9.7 months) after re-RT. Locoregional recurrence-free survival was 95.2%, 70.2%, 64.8% at 6, 12, and 24 months, respectively. OS was 100%, 79.2%, and 79.2% at 6, 12, and 24 months, respectively. Four patients had osteoradionecrosis on imaging a median of 13.2 months (IQR, 8.7-17.4 months) after re-RT, with 2 requiring surgical intervention. Conclusions: Adjuvant re-RT for patients with HNSCC was well-tolerated and offered reasonable local control in this high-risk cohort but appears to be associated with a risk of osteoradionecrosis. Additional study and longer follow-up could help define optimal patient management in this patient population. Competing Interests: Marshall Posner reports royalties or licenses from Beth Israel Deaconess Medical Center; consulting fees from Naveris, Hookipa, Cel-SCI; participation on a Data Safety Monitoring Board or Advisory Board with Merck, Calliditas, Frizent, and Vivant Therapeutics. The remaining authors declare that they have no conflict of interest. (© 2023 The Author(s).)
Databáze:	MEDLINE
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