Cancer Research and Treatment

Original Articles

Head and Neck cancer

Re-irradiation with Moderate Hypo-fractionation Using Intensity Modulated Photon or Proton Radiation Therapy in Locally Recurrent Squamous Cell Carcinoma of Nasopharynx: Heerim Nam, Yong Chan Ahn, Kyungmi Yang, Dongryul Oh, Jae Myoung Noh; Cancer Res Treat. 2022;54(1):96-108. Published online March 26, 2021; DOI: https://doi.org/10.4143/crt.2020.1349

Purpose
This study aimed to analyze the treatment outcomes of locally recurrent nasopharyngeal cancer (NPC) patients following moderate hypo-fractionation re-irradiation (re-RT).
Materials and Methods
Sixty locally recurrent NPC patients underwent hypo-fractionation re-RT. Forty-eight point three percentage had rT3-4, and 30.0% did keratinizing squamous cell carcinoma. Intensity-modulated radiation therapy (IMRT), with or without intensity-modulated proton therapy (IMPT), was used in 66.7% of patients.
Results
With the median follow-up of 22 months (range, 2 to 254 months), 31 patients (51.7%) died, 38 (63.3%) developed further treatment failure, and 30 (50.0%) developed ≥ grade 3 toxicity (including seven grade 5) at time of analysis. The 2- and 5-year rates of overall survival, local failure-free survival, and ≥ grade 3 toxicity-free survival were 57.9% and 45.8%, 64.1% and 52.5%, and 54.8% and 44.9%, respectively. In multivariate analyses, worse factors for overall survival (OS) were iT3-4 (p=0.010) and age at re-RT ≥ 53 years (p=0.003), those for local failure-free survival (LFFS) were rT3-4 (p=0.022) and rN0-1 (p=0.035), and those for toxicity-free survival (TFS) were iT3-4 (p=0.020) and re-IMRT/IMPT (p=0.030), respectively. Cumulative dose or fraction size ≥ 3 Gy at re-RT, however, showed no significance for OS, LFFS and TFS.
Conclusion
Current re-RT with modern RT techniques by moderate hypo-fractionation scheme seemed feasible in treating locally recurrent NPC patients.

Citations

Citations to this article as recorded by

Case Report: Unresectable recurrent nasopharyngeal cancer treated with immuno oncology
Fabiano Flauto, Rosa Maria Di Crescenzo, Vincenzo Damiano
Frontiers in Oncology.2025;[Epub] CrossRef
Radiation oncology for the rhinologist
Helena Levyn, Fan Yang, Nancy Y. Lee
Current Opinion in Otolaryngology & Head & Neck Surgery.2024; 32(1): 5. CrossRef
Identifying the prognostic value of MRI-based tumor response and predicting the risk of radio-resistance in re-radiotherapy for locally recurrent nasopharyngeal carcinoma
Zi-Jian Lu, Ting Liu, Jie-Yi Lin, Sheng-Ting Pei, Ling Guo, Sai-Lan Liu, Hai-Qiang Mai
Radiotherapy and Oncology.2023; 183: 109635. CrossRef
Low-dose radiotherapy effects the progression of anti-tumor response
Lei Gao, Anqi Zhang
Translational Oncology.2023; 35: 101710. CrossRef
The Role of Hypofractionation in Proton Therapy
Alexandre Santos, Scott Penfold, Peter Gorayski, Hien Le
Cancers.2022; 14(9): 2271. CrossRef
Toxicity Profiles and Survival Outcomes Among Patients With Nonmetastatic Nasopharyngeal Carcinoma Treated With Intensity-Modulated Proton Therapy vs Intensity-Modulated Radiation Therapy
Xingzhe Li, Sarin Kitpanit, Anna Lee, Dennis Mah, Kevin Sine, Eric J. Sherman, Lara A. Dunn, Loren S. Michel, James Fetten, Kaveh Zakeri, Yao Yu, Linda Chen, Jung Julie Kang, Daphna Y. Gelblum, Sean M. McBride, Chiaojung J. Tsai, Nadeem Riaz, Nancy Y. Lee
JAMA Network Open.2021; 4(6): e2113205. CrossRef

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High-Dose Thoracic Re-irradiation of Lung Cancer Using Highly Conformal Radiotherapy Is Effective with Acceptable Toxicity: Ji Hyun Hong, Yeon-Sil Kim, Sea-Won Lee, So Jung Lee, Jin Hyung Kang, Suk Hee Hong, Ju-Young Hong, GeumSeong Cheon; Cancer Res Treat. 2019;51(3):1156-1166. Published online November 29, 2018; DOI: https://doi.org/10.4143/crt.2018.472

Abstract PDF PubReader ePub

Purpose
Thoracic re-irradiation (re-RT) of lung cancer has been challenged by the tolerance doses of normal tissues. We retrospectively analyzed local control, overall survival (OS) and toxicity after thoracic re-RT using highly conformal radiotherapy, such as intensity modulated radiotherapy and stereotactic body radiotherapy.
Materials and Methods
Thirty-one patients who received high-dose thoracic re-RT were analyzed. Doses were recalculated to determine biologically equivalent doses. The median interval to re-RT was 15.1 months (range, 4.4 to 56.3 months), the median initial dose was 79.2 Gy₁₀ (range, 51.75 to 150 Gy₁₀), and the median re-RT dose was 68.8 Gy₁₀ (range, 43.2 to 132 Gy₁₀).
Results
Eighteen (58.1%) and eleven (35.5%) patients showed loco-regional recurrence and distant metastasis, respectively, after 17.4 months of median follow-up. The 1-year and 2-year local control rates were 60.2% and 43.7%, respectively. The median loco-regional recurrence-free-survival (LRFS) was 15.4 months, and the median OS was 20.4 months. The cumulative and re-RT biologically equivalent dose for α/β=10 (BED₁₀) doses were the most significant prognostic factors. Cumulative BED₁₀≥145 Gy₁₀ and re-RT BED₁₀≥68.7 Gy₁₀ were significantly associated with longer OS (p=0.029 and p=0.012, respectively) and LRFS (p=0.003 and p=0.000, respectively). The most frequent acute toxicity was grade 1-2 pulmonary toxicity (41.9%). No acute grade 3 or higher toxicities occurred.
Conclusion
Our results show that high-dose thoracic re-RT of lung cancer can be safely delivered using highly conformal radiotherapy with favorable survival and acceptable toxicity. An optimal strategy to select patients who would benefit from re-RT is crucial in extending the indications and improving the efficacy with a sufficiently high dose.

Citations

Citations to this article as recorded by

Stereotactic Lung Re-Irradiation After a First Course of Stereotactic Radiotherapy with In-Field Relapse: A Valuable Option to Be Considered
Assim Sahin, Edouard Romano, Alessio Casutt, Raphaël Moeckli, Véronique Vallet, Shaïma El Chammah, Mahmut Ozsahin, Rémy Kinj
Cancers.2025; 17(3): 366. CrossRef
ACR-ARS Practice Parameter for the Performance of Proton Beam Therapy
Steven J. Frank, Indra J. Das, Charles B. Simone, Brian J. Davis, Curtiland Deville, Zhongxing Liao, Simon S. Lo, Susan L. McGovern, Rahul R. Parikh, Michael Reilly, William Small, Naomi R. Schechter
International Journal of Particle Therapy.2024; 13: 100021. CrossRef
Ultra-Hypofractionated Re-Irradiation with Anti-PD-1 Immunotherapy for Locoregionally Recurrent (after Radical Chemo-Radiotherapy) Non-Small Cell Lung Cancer
Konstantinos Filippatos, Ioannis M. Koukourakis, Stavros Anevlavis, Axiotis Giaktzidis, Michael I. Koukourakis
Cancers.2023; 15(20): 5083. CrossRef
Re-irradiation for intra-thoracic tumours and extra-thoracic breast cancer: dose accumulation, evaluation of efficacy and toxicity based on a literature review
Dorota Gabrys, Roland Kulik, Agnieszka Namysł-Kaletka
The British Journal of Radiology.2022;[Epub] CrossRef
High Dose Thoracic Re-Irradiation and Chemo-Immunotherapy for Centrally Recurrent NSCLC
Brane Grambozov, Markus Stana, Bernhard Kaiser, Josef Karner, Sabine Gerum, Elvis Ruznic, Barbara Zellinger, Raphaela Moosbrugger, Michael Studnicka, Gerd Fastner, Felix Sedlmayer, Franz Zehentmayr
Cancers.2022; 14(3): 573. CrossRef
Toxicity of Proton Therapy versus Photon Therapy on Salvage Re-Irradiation for Non-Small Cell Lung Cancer
Kyungmi Yang, Yang-Gun Suh, Hyunju Shin, Hongryull Pyo, Sung Ho Moon, Yong Chan Ahn, Dongryul Oh, Eunah Chung, Kwanghyun Jo, Jae Myoung Noh
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Salvage proton beam therapy for locoregional recurrence of non-small cell lung cancer
Hyunju Shin, Jae Myoung Noh, Hongryull Pyo, Yong Chan Ahn, Dongryul Oh
Radiation Oncology Journal.2021; 39(1): 24. CrossRef
Thoracic re-irradiation with 3D-conformal or more advanced techniques: A systematic review of treatment safety by the Re-irradiation Study Group of the Italian Association of Radiation and Oncology AIRO
Marta Maddalo, Elisa D’Angelo, Francesco Fiorica, Angela Argenone, Melissa Scricciolo, Salvatore Cozzi, Alessia Nardangeli, Francesco Dionisi, Gianluca Costantino, Stefano Vagge, Antonio Pontoriero, Vittorio Donato, Mariangela Massaccesi
Critical Reviews in Oncology/Hematology.2021; 167: 103500. CrossRef
Radiotherapy for head and neck tumours using an oral fixation and parameter acquisition device and TOMO technology: a randomised controlled study
Xiaofang Zhang, Tianlu Wang, Xinyan Xiao, Xia Li, Chen Yu Wang, Bo Huang, Lei He, Yingqiu Song
BMJ Open.2021; 11(11): e052542. CrossRef
The Medical Physics Management of Reirradiation Patients
Kelly C. Paradis, Martha M. Matuszak
Seminars in Radiation Oncology.2020; 30(3): 204. CrossRef
Reirradiation at local relapse of non-small cell lung cancer
D.V. Gogolin, I.A. Gulidov, Y.S. Mardynsky, T.Y. Antonenko, A.Y. Buksha
Onkologiya. Zhurnal imeni P.A.Gertsena.2020; 9(3): 48. CrossRef

8,581 View
256 Download
10 Web of Science
11 Crossref

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