Proton re-irradiation of unresectable recurrent head and neck cancers

Abstract

Background: This study presents a retrospective analysis (efficacy and toxicity) of outcomes in patients with unresectable recurrence of previously irradiated head and neck (h&N) cancers treated with proton therapy. Locoregional recurrence is the main pattern of failure in the treatment of h&N cancers. proton re-irradiation in patients with relapse after prior radiotherapy might be valid as promising as a challenging treatment option. Materials and methods: From November 2015 to January 2020, 30 patients with in-field recurrence of head and neck cancer, who were not suitable for surgery due to medical contraindications, tumor localization, or extent, received re-irradiation with intensity-modulated proton therapy (IMpT). sites of retreatment included the aerodigestive tract (60%) and the base of skull (40%). The median total dose of prior radiotherapy was 55.0 Gy. The median time to the second course was 38 months. The median re-irradiated tumor volume was 158.1 cm3. patients were treated with 2.0, 2.4, and 3.0 GyrBe per fraction, with a median equivalent dose (eQD2) of 57.6 Gy (a/b = 10). radiation-induced toxicity was recorded according to the rTOG/eOrTc criteria. results: The 1- and 2-year local control (Lc), progression-free survival (pFs), and overall survival (Os) were 52.6/21.0, 21.9/10.9, and 73.4/8.4%, respectively, with a median follow-up time of 21 months. The median overall survival was 16 months. acute grade 3 toxicity was observed in one patient (3.3%). There were five late severe side effects (16.6%), with one death associated with re-irradiation. conclusion: re-irradiation with a proton beam can be considered a safe and efficient treatment even for a group of patients with unresectable recurrent h&N cancers.