Deuces.
Top Line: What are folks doing these days for head and neck (H&N) reirradiation?
The Study: The newest Red Journal will help keep you up with the times. The first of three reports on multi-institutional retrospective cohorts included patients with recurrent or second primary H&N cancer treated with IMRT reirradiation (about half post-operatively) to a site previously receiving at least 40 Gy. Interestingly people seemed to get bolder with time, treating larger volumes with higher doses. Neither elective nodal coverage nor altered fractionation improved local control but both led to more toxicity--though grade 3 and higher toxicities wasn’t as bad as you might think (22% acute and 17% late). For those with gross disease, doses of 66 Gy or higher were associated with better survival. A second report creates a recursive partitioning analysis (RPA) to stratify patients receiving reirradiation into three classes to effectively predict survival. A third (eerily) similar report, this time including SBRT reirradiation, demonstrated that outcomes with SBRT seem similar to IMRT and that patients with RPA class III (i.e., treatment intervals <2 years with a feeding tube or tracheostomy) do poorly no matter what.
Bottom Line: H&N reirradiation to sites of known disease via either conventionally fractionated IMRT to doses as high as 66 Gy or SBRT is relatively safe and effective for most people, and there's a way for you to predict which people those are.
The Study: The newest Red Journal will help keep you up with the times. The first of three reports on multi-institutional retrospective cohorts included patients with recurrent or second primary H&N cancer treated with IMRT reirradiation (about half post-operatively) to a site previously receiving at least 40 Gy. Interestingly people seemed to get bolder with time, treating larger volumes with higher doses. Neither elective nodal coverage nor altered fractionation improved local control but both led to more toxicity--though grade 3 and higher toxicities wasn’t as bad as you might think (22% acute and 17% late). For those with gross disease, doses of 66 Gy or higher were associated with better survival. A second report creates a recursive partitioning analysis (RPA) to stratify patients receiving reirradiation into three classes to effectively predict survival. A third (eerily) similar report, this time including SBRT reirradiation, demonstrated that outcomes with SBRT seem similar to IMRT and that patients with RPA class III (i.e., treatment intervals <2 years with a feeding tube or tracheostomy) do poorly no matter what.
Bottom Line: H&N reirradiation to sites of known disease via either conventionally fractionated IMRT to doses as high as 66 Gy or SBRT is relatively safe and effective for most people, and there's a way for you to predict which people those are.
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