Prospective trial of high-dose reirradiation using daily image guidance with intensity-modulated radiotherapy for recurrent and second primary head-and-neck cancer.
OBJECTIVE
To report a single-institutional experience using intensity-modulated radiotherapy with daily image-guided radiotherapy for the reirradiation of recurrent and second cancers of the head and neck.


METHODS
Twenty-one consecutive patients were prospectively treated with intensity-modulated radiotherapy from February 2006 to March 2009 to a median dose of 66 Gy (range, 60-70 Gy). None of these patients received concurrent chemotherapy. Daily helical megavoltage CT scans were obtained before each fraction as part of an image-guided radiotherapy registration protocol for patient alignment.


RESULTS
The 1- and 2-year estimates of in-field control were 72% and 65%, respectively. A total of 651 daily megavoltage CT scans were obtained. The mean systematic shift to account for interfraction motion was 1.38 ± 1.25 mm, 1.79 ± 1.45 mm, and 1.98 ± 1.75 mm for the medial-lateral, superior-inferior, and anterior-posterior directions, respectively. Pretreatment shifts of >3 mm occurred in 19% of setups in the medial-lateral, 27% in the superior-inferior, and 33% in the anterior-posterior directions, respectively. There were no treatment-related fatalities or hospitalizations. Complications included skin desquamation, odynophagia, otitis externa, keratitis, naso-lacrimal duct stenosis, and brachial plexopathy.


CONCLUSIONS
Intensity-modulated radiotherapy with daily image guidance results in effective disease control with relatively low morbidity and should be considered for selected patients with recurrent and second primary cancers of the head and neck.
Chen
Allen M
AM
Department of Radiation Oncology, University of California, Davis Cancer Center, Sacramento, CA 95817, USA. allen.chen@ucdmc.ucdavis.edu
Farwell
D Gregory
DG
Luu
Quang
Q
Cheng
Suzan
S
Donald
Paul J
PJ
Purdy
James A
JA
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D056888:Patient Positioning; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D019233:Retreatment / Q000379:methods; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden