reirradiation

Reirradiation for Recurrent Head and Neck Cancer

Source: Medscape News Date: November 29, 2012 Abstract Recurrence of head and neck cancer in a previously irradiated volume presents a challenging problem and has poor prognosis. A minority of patients are eligible for the preferred therapy, surgical resection. Systemic therapy is offered to patients with unresectable disease but offers little, if any, chance of cure. Repeat irradiation with systemic therapy is a potentially curative option. One randomized trial and several cooperative group and institutional studies support its use. Long-term disease-free survival has been observed, albeit with the risk of significant, possibly life threatening, late complications. Intensity-modulated radiotherapy has been shown to reduce toxicity and improve disease control. Novel systemic therapies and radiotherapy techniques, including stereotactic body radiotherapy, are under active study. Introduction Radiation therapy plays a central role in the treatment of head and neck cancer (HNC) patients. Within a treatment paradigm of functional organ preservation, evidence-based guidelines recommend radiotherapy for three quarters of all patients with HNC. [1] Both organ-preserving definitive chemoradiotherapy (CRT) and selective postoperative CRT improve locoregional recurrence (LRR) and prolong overall survival (OS). [2,3] Nevertheless, despite improvements, LRR after CRT continues to be a vexing problem for 20–35% of patients. [4–8] Even patients with favorable prognosis human papillomavirus-related HNC [9] have a LRR rate of nearly 15%. [4] Locoregional recurrence is related to a number of different factors. Some tumors are inherently radioresistant. Additionally, as radiation is delivered more precisely with smaller margins, the potential for recurrences related to 'marginal misses' has increased. Ongoing exposure [...]

Charlotte Parker2012-12-05T14:26:22-07:00December, 2012|Oral Cancer News|

New Guidelines for Head & Neck Cancer Reirradiation

Source: PhysciansWeekly.com Recurrent and second primary head-and-neck squamous cell carcinomas arising within or close to previously irradiated areas are a significant clinical challenge. The American College of Radiology published appropriateness criteria for recurrent head and neck cancer after prior definitive radiation. Recurrent and second primary head-and-neck squamous cell carcinomas (HNSCC) arising within or close to previously irradiated areas are a significant clinical challenge. Salvage surgical resection is the standard of care, but reirradiation is the only potentially curative treatment when surgery is not an option. Reirradiation is more challenging than initial treatment because of the side effects of prior therapy and concerns about the risks of high cumulative radiation doses to normal structures. Multi-institutional trials and large single institutional experiences have demonstrated that aggressive reirradiation, most often with chemotherapy, is feasible and provides durable locoregional control in some patients. An Expert Consensus on Reirradiation In the August 1, 2011 International Journal of Radiation Oncology * Biology * Physics, the American College of Radiology (ACR) published appropriateness criteria for recurrent head and neck cancer after prior definitive radiation. The ACR expert panel recommended that patient evaluation and reirradiation for HNSCC be performed at a tertiary care center with a head and neck oncology team that is equipped with the resources and experience to manage the complexities and toxicities of retreatment. Evaluation of Patients with Head & Neck Cancer Patient evaluation is important in assuring only appropriate patients are offered reirradiation. Evaluation should include careful restaging imaging, a detailed history and assessment [...]

Charlotte Parker2012-08-20T10:43:31-07:00August, 2012|Oral Cancer News|

Reirradiation Effective in Post-Radiation Sarcoma

Source: MedScape Today News Reirradiation plus hyperthermia is an effective treatment for radiation-associated sarcoma (RAS) and could even cure some of these rare tumors, a small new study suggests. "The reirradiation plus hyperthermia as we used it appears to be quite successful with a very high response rate and reasonable local control rate," Dr. Geertjan van Tienhoven of the Academic Medical Center in Amsterdam, one of the study's authors, told Reuters Health. RAS develops in areas previously reirradiated with 25 to 80 Gray, usually with a latency period of three years or more, and with a different histology from the original tumor, according to a June 28th online paper in Cancer. Dr. van Tienhoven predicts that "radiation-associated sarcomas are going to be more frequent in the future, because of an increasing prevalence of breast cancer survivors who are at risk, be it a low risk, for RAS." These tumors are usually resected with radical surgery and sometimes adjuvant chemotherapy. To date, according the paper, there haven't been any randomized trials or other prospective studies of reirradiation for RAS. "Many papers and textbooks state that radiation shouldn't be done in these tumors because they are caused by radiation. Indeed it sounds counterintuitive to irradiate again," Dr. van Tienhoven said in an interview. But using hyperthermia with reirradiation allows for a lower radiation dose, he and his coauthors explain. The Academic Medical Center and the Institute Verbeeten have "extensive experience" with this approach, for example in breast cancer recurrence in previously irradiated [...]

Oral Cancer Foundation News Team - A2011-08-09T10:29:53-07:00August, 2011|Oral Cancer News|

Study identifies patients best suited to second round of head-and-neck treatment

Source: http://www.oncologynurseadvisor.com/ Author: Delicia Honen Yard A small group of patients with recurrent or second primary head and neck cancer achieved long-term cure after undergoing concomitant chemotherapy with reirradiation. However, the associated risk of severe toxicity demonstrated that only carefully selected patients should undergo treatment readministration. Joseph Salama, MD, formerly with the University of Chicago (Illinois), and colleagues analyzed data from 166 patients with head and neck cancer who had received a first round of radiation followed by a second round plus chemotherapy because their cancer recurred or because they developed a new tumor. After a median follow-up of 53 months among surviving patients, median overall survival was 10.3 months. The 2-year rates for overall survival, disease-free survival, locoregional control, and freedom from distant metastasis were 24.8%, 19.9%, 50.7%, and 61.4%, respectively. Despite yielding a 2-year cure rate of nearly a quarter of the subjects, the second course of treatment was highly toxic: 33 participants (19.9%) died of treatment-related toxicity, and some lost the ability to speak or swallow. The investigators found that certain patients benefited from the second treatment over others: Those who were cancer-free for a longer period of time, did not have chemotherapy with their first course of radiation, were treated with a higher dose of radiation in their second round, and had surgical resection or debulking prior to the second course of radiation were more likely to be cured at 2 years than those who had none or only some of these features. “This can help doctors determine [...]

Oral Cancer Foundation News Team - A2011-07-03T09:12:41-07:00July, 2011|Oral Cancer News|

Certain head and neck cancer patients benefit from second round of treatment

Source: www.eureka.org Author: press release A new study has determined predictors that can better identify patients who will benefit from a potentially toxic second course of treatment, which offers a small but real chance of cure in select patients with head and neck cancer. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the findings could help guide treatment decisions for head and neck cancer patients. Radiation is often used to treat patients with head and neck cancer. If their cancer reappears, they have limited treatment choices: chemotherapy is not curative, and surgery can be curative but is often not possible. Chemotherapy and a second course of radiation have previously been shown to be another option. Joseph Salama, MD, formerly of the University of Chicago, and his colleagues conducted an analysis of prior studies to determine how patients tolerate this second round of treatment and which patients benefit the most from it. The investigators analyzed data from 166 patients with head and neck cancer who received a first round of radiation followed by a second round plus chemotherapy because their cancer recurred or they developed a new tumor. The second course of treatment could cure approximately 25 percent of patients at two years, but it was quite toxic. (Some patients lost the ability to speak or swallow. In addition, approximately 20 percent of patients died from treatment-related complications.) Certain patients benefited from the treatment over others. Those who were cancer-free for a longer period of time, [...]

Oral Cancer Foundation News Team - A2011-06-13T21:30:52-07:00June, 2011|Oral Cancer News|

Reirradiation with intensity-modulated radiotherapy in recurrent head and neck cancer.

Source: HighWire- Stanford University In this retrospective investigation we analyzed outcome and toxicity after intensity-modulated reirradiation of recurrent head and neck cancer. METHODS: Thirty-eight patients with local recurrent head and neck cancer were evaluated. The median dose of initial radiotherapy was 61 Gy. Reirradiation was carried out with step-and-shoot intensity-modulated radiotherapy (median dose: 49 Gy). RESULTS: Median overall survival was 17 months, and the 1- and 2-year overall survival rates were 63% and 34%. The 1- and 2-year local control rates were 57% and 53%. Distant spread occurred in 34%, and reirradiation induced considerable late toxicity in 21% of the patients. Thirty-two percent showed increased xerostomia after reirradiation. The risk for xerostomia was significantly higher for cumulative mean doses of ?45 Gy to parotid glands. Considering median cumulative maximum doses of 53 Gy to the spinal cord and 63 Gy to the brainstem, no late toxicities were observed. CONCLUSIONS: Reirradiation with intensity-modulated radiotherapy in recurrent head and neck cancer is feasible with acceptable toxicity and yields encouraging rates of local control and overall survival. � 2011 Wiley Periodicals, Inc. Head Neck, 2011.

Oral Cancer Foundation News Team - A2011-02-09T11:45:36-07:00February, 2011|Oral Cancer News|

Prognostic factors for survival after salvage reirradiation of head and neck cancer

Source: Journal of Clinical Oncology, Vol 27, No 12 (April 20), 2009: pp. 1983-1991 Authors: Tawee Tanvetyanon et al. Purpose: Patients who develop recurrent or new primary head and neck cancer in a previously irradiated site have poor prognosis. Reirradiation is a treatment option, although it is associated with substantial toxicities. We investigated potential prognostic factors, including comorbidity and pre-existing organ dysfunction, for survival after reirradiation. Methods: Institutional electronic records of patients treated with reirradiation between January 1998 and 2008 were reviewed. Comorbidity was assessed by Charlson index and Adult Comorbidity Evaluation-27 (ACE-27) grading. Organ dysfunction was defined as feeding tube dependency, functioning tracheostomy, or soft tissue defect. Results: There were 103 patients, including 46 patients who underwent salvage surgery before reirradiation. Median progression-free and overall survivals were 12.1 months (95% CI, 9.7 to 16.6) and 19.3 months (95% CI, 13.9 to 29.9), respectively. Significant comorbidity was present in 36% of patients by Charlson index and 24% by ACE-27. Baseline organ dysfunction was present in 37% of patients. Median overall survivals were 5.5 months among those with both organ dysfunction and comorbidity per Charlson index, and 4.9 months per ACE-27, compared with 59.6 and 44.2 months, respectively, among the patients with neither organ dysfunction nor comorbidity (P

Oral Cancer Foundation News Team - A2009-04-17T12:31:32-07:00April, 2009|Oral Cancer News|

Reirradiation may extend life in head and neck cancers

Source: www.modernmedicine.com Author: staff For some patients, reirradiation of recurrent head and neck cancer can extend life. But for those with comorbidities or organ dysfunction, such as feeding tube dependence, it is likely to offer only palliative support, according to a report in the March 16 issue of the Journal of Clinical Oncology. Tawee Tanvetyanon, M.D., of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla., and colleagues reviewed medical records of 103 patients with head and neck cancer who received reirradiation at the center between 1998 and 2008. In an effort to determine prognostic factors for success, researchers analyzed the data using both the Charlson index and Adult Comorbidity Evaluation-27 (ACE-27). The investigators found significant comorbidity in 36 percent of the study group with the Charlson index and 24 percent with the ACE-27; organ dysfunction occurred in 37 percent of patients. For patients with both organ dysfunction and comorbidity, median overall survival was 5.5 months (Charlson) and 4.9 months (ACE-27). This compared with 59.6 months (Charlson) and 44.2 months (ACE-27) for patients who did not have either organ dysfunction or comorbidity, the researchers report. Lesser prognostic factors were stage of recurrent tumor, tumor size and reirradiation dose. "For patients with favorable risk factors, reirradiation should be strongly considered as it offers the promise of long-term survival. For patients with poor risk factors, however, such promise is unlikely," the authors write.

Oral Cancer Foundation News Team - A2009-03-24T05:20:22-07:00March, 2009|Oral Cancer News|

Prognostic Factors for Survival After Salvage Reirradiation of Head and Neck Cancer

Source: Journal of Clinical Oncology Writer: Tawee Tanvetyanon, Tapan Padhya, Judith McCaffrey, Weiwei Zhu, David Boulware, Ronald DeConti, and Andrea Trotti From the Head and Neck and Thoracic Programs, and the Statistic Core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. Purpose: Patients who develop recurrent or new primary head and neck cancer in a previously irradiated site have poor prognosis. Reirradiation is a treatment option, although it is associated with substantial toxicities. We investigated potential prognostic factors, including comorbidity and pre-existing organ dysfunction, for survival after reirradiation. Methods: Institutional electronic records of patients treated with reirradiation between January 1998 and 2008 were reviewed. Comorbidity was assessed by Charlson index and Adult Comorbidity Evaluation-27 (ACE-27) grading. Organ dysfunction was defined as feeding tube dependency, functioningtracheostomy, or soft tissue defect. Results: There were 103 patients, including 46 patients who underwent salvage surgery before reirradiation. Median progression-free and overall survivals were 12.1 months (95% CI, 9.7 to 16.6) and 19.3 months (95% CI, 13.9 to 29.9), respectively. Significant comorbidity was present in 36% of patients by Charlson index and 24% by ACE-27. Baseline organ dysfunction was present in 37% of patients. Median overall survivals were 5.5 months among those with both organ dysfunction and comorbidity per Charlson index, and 4.9 months per ACE-27, compared with 59.6 and 44.2 months, respectively, among the patients with neither organ dysfunction nor comorbidity (P) .001 and < .001). Other independent prognostic factors were interval from previous radiation, recurrent tumor stage, tumor bulk at reirradiation, [...]

Webmaster2009-03-17T20:24:51-07:00March, 2009|Oral Cancer News|