TY - JOUR
T1 - Patient-oriented toxicity endpoints after head and neck reirradiation with intensity modulated radiation therapy
AU - Margalit, Danielle N.
AU - Schoenfeld, Jonathan D.
AU - Rawal, Bhupendra
AU - Haddad, Robert I.
AU - Catalano, Paul J.
AU - Goguen, Laura A.
AU - Chau, Nicole G.
AU - Rabinowits, Guilherme
AU - Lorch, Jochen H.
AU - Annino, Donald J.
AU - Tishler, Roy B.
N1 - Funding Information:
Funding was provided by the Department of Radiation Oncology, Dana-Farber/Brigham & Women’s Cancer Center.
Publisher Copyright:
© 2017 Elsevier Ltd
PY - 2017/10
Y1 - 2017/10
N2 - Objectives To characterize specific serious toxicities of reRT with intensity modulated radiation therapy (IMRT) for squamous cell carcinoma of the head and neck (SCCHN) and identify treatment-related predictors of toxicity for patient counseling and decision-making. Materials/Methods 75 consecutive patients with recurrent or 2nd primary SCCHN received reRT from 8/2004-02/2013. All patients had prior definitive or postoperative RT. Objective endpoints of “serious toxicity” were defined as: hospitalization during reRT, tracheotomy after reRT, hemorrhage, soft tissue complication requiring operative intervention, or other CTCAE grade ≥4 toxicity. Results Patients received definitive (n = 41,55%) or postoperative (n = 34,45%) reRT (median dose 60 Gy, range 59.4–70 Gy). Most patients (88%) had concurrent chemotherapy. With a median follow-up of 1.4 years, 39 (52%) patients had at least one serious toxicity: hospitalization during reRT (24%), surgically-managed soft tissue complication (19%), and/or urgent tracheotomy (18%). There were no grade 5 acute toxicities but there were 4 fatal hemorrhages (median 8.3 months) including 2 attributed to local-regional recurrence (LRR). Most patients (69%) had a percutaneous endoscopic gastrostomy (PEG) tube at last follow-up; those with a LRR had higher PEG tube-dependence rates (86% vs. 53%, p = 0.001). LRR, site of reRT, and laryngeal RT dose, were marginally associated with toxicity-risk. Conclusions Patients considering reRT should be counseled on the high rate of PEG tube-dependence, and events of urgent tracheotomy, hospitalization, hemorrhage, and operative intervention, which typically occur months after reRT completion. Further study of baseline patient function and cumulative radiation dose to the larynx and other organs-at-risk may improve estimates of serious toxicity-risk after reRT.
AB - Objectives To characterize specific serious toxicities of reRT with intensity modulated radiation therapy (IMRT) for squamous cell carcinoma of the head and neck (SCCHN) and identify treatment-related predictors of toxicity for patient counseling and decision-making. Materials/Methods 75 consecutive patients with recurrent or 2nd primary SCCHN received reRT from 8/2004-02/2013. All patients had prior definitive or postoperative RT. Objective endpoints of “serious toxicity” were defined as: hospitalization during reRT, tracheotomy after reRT, hemorrhage, soft tissue complication requiring operative intervention, or other CTCAE grade ≥4 toxicity. Results Patients received definitive (n = 41,55%) or postoperative (n = 34,45%) reRT (median dose 60 Gy, range 59.4–70 Gy). Most patients (88%) had concurrent chemotherapy. With a median follow-up of 1.4 years, 39 (52%) patients had at least one serious toxicity: hospitalization during reRT (24%), surgically-managed soft tissue complication (19%), and/or urgent tracheotomy (18%). There were no grade 5 acute toxicities but there were 4 fatal hemorrhages (median 8.3 months) including 2 attributed to local-regional recurrence (LRR). Most patients (69%) had a percutaneous endoscopic gastrostomy (PEG) tube at last follow-up; those with a LRR had higher PEG tube-dependence rates (86% vs. 53%, p = 0.001). LRR, site of reRT, and laryngeal RT dose, were marginally associated with toxicity-risk. Conclusions Patients considering reRT should be counseled on the high rate of PEG tube-dependence, and events of urgent tracheotomy, hospitalization, hemorrhage, and operative intervention, which typically occur months after reRT completion. Further study of baseline patient function and cumulative radiation dose to the larynx and other organs-at-risk may improve estimates of serious toxicity-risk after reRT.
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U2 - 10.1016/j.oraloncology.2017.08.012
DO - 10.1016/j.oraloncology.2017.08.012
M3 - Article
C2 - 28939070
AN - SCOPUS:85028939257
SN - 1368-8375
VL - 73
SP - 160
EP - 165
JO - Oral Oncology
JF - Oral Oncology
ER -