Reirradiation of Head and Neck Cancers With Proton Therapy: Outcomes and Analyses.
Reirradiation of 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.



We retrospectively reviewed the records of patients who received H&N reirradiation with PRT from April 2011 through June 2015. Patients reirradiated with palliative intent or without prior documentation of H&N radiation therapy were excluded. Radiation-related toxicities were recorded according to the Common Terminology Criteria for Adverse Events Version 4.0.



The conditions of 60 patients were evaluated, with a median follow-up time of 13.6 months. Fifteen patients (25%) received passive scatter proton therapy (PSPT), and 45 (75%) received intensity modulated proton therapy (IMPT). Thirty-five patients (58%) received upfront surgery, and 44 (73%) received concurrent chemotherapy. The 1-year rates of locoregional failure-free survival, overall survival, progression-free survival, and distant metastasis-free survival were 68.4%, 83.8%, 60.1%, and 74.9%, respectively. Eighteen patients (30%) experienced acute grade 3 (G3) toxicity, and 13 (22%) required a feeding tube at the end of PRT. The 1-year rates of late G3 toxicity and feeding tube independence were 16.7% and 2.0%, respectively. Three patients may have died of reirradiation-related effects (1 acute and 2 late).



Proton beam therapy can be a safe and effective curative reirradiation strategy, with acceptable rates of toxicity and durable disease control.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jack
J
Phan
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona.
Terence T
TT
Sio
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Theresa P
TP
Nguyen
Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio.
Vinita
V
Takiar
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
G Brandon
GB
Gunn
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Adam S
AS
Garden
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
David I
DI
Rosenthal
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Clifton D
CD
Fuller
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
William H
WH
Morrison
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Beth
B
Beadle
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Dominic
D
Ma
Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
Mark E
ME
Zafereo
Department of Speech Pathology University of Texas MD Anderson Cancer Center, Houston, Texas.
Kate A
KA
Hutcheson
Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
Michael E
ME
Kupferman
Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
William N
WN
William
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: sjfrank@mdanderson.org.
Steven J
SJ
Frank
D000328:Adult; D000368:Aged; D015984:Causality; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control; D010166:Palliative Care / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D061766:Proton Therapy / Q000401:mortality* / Q000706:statistics & numerical data; D011832:Radiation Injuries / Q000401:mortality* / Q000517:prevention & control; D020266:Radiotherapy, Conformal / Q000401:mortality / Q000706:statistics & numerical data; D000069475:Re-Irradiation / Q000401:mortality* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome