IMRT reirradiation of head and neck cancer-disease control and morbidity outcomes.
OBJECTIVE
Institutional and cooperative group experience has demonstrated the feasibility of reirradiation for head and neck cancer. Limited data are available regarding the use of intensity-modulated radiotherapy (IMRT) for this indication. We reviewed our initial experience using IMRT for previously irradiated head and neck cancer patients.


METHODS
Records of 78 consecutive patients reirradiated with IMRT for head and neck cancer between 1999 and 2004 were reviewed; 74 cases were analyzed. Reirradiation was defined as any overlap between original and new radiation treatment volumes regardless of the time interval between initial and subsequent treatment. Severe reirradiation-related toxicity was defined as toxic events resulting in hospitalization, corrective surgery, or patient death. Longitudinal estimates of survival were calculated by Kaplan-Meier technique.


RESULTS
Twenty (27%) patients underwent salvage surgical resection and 36 (49%) patients received chemotherapy. Median follow-up from reirradiation was 25 months. Median time interval between initial radiation and reirradiation was 46 months. Median reirradiation dose was 60 Gy. Median lifetime radiation dose was 116.1 Gy. The 2-year overall survival and locoregional control rates were 58% and 64%, respectively. Severe reirradiation related toxicity occurred in 15 patients (20%); one treatment-related death was observed.


CONCLUSIONS
The use of IMRT for reirradiation of recurrent or second primary head and neck cancers resulted in encouraging local control and survival. Reirradiation-related morbidity was significant, but may be less severe than previously published reports using conventional techniques.
Sulman
Erik P
EP
Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Schwartz
David L
DL
Le
Thuy T
TT
Ang
K Kian
KK
Morrison
William H
WH
Rosenthal
David I
DI
Ahamad
Anesa
A
Kies
Merril
M
Glisson
Bonnie
B
Weber
Randal
R
Garden
Adam S
AS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods / Q000401:mortality; D019233:Retreatment / Q000009:adverse effects; D012189:Retrospective Studies; D016879:Salvage Therapy; D055815:Young Adult