Adjuvant Reirradiation With Proton Therapy in Head and Neck Squamous Cell Carcinoma

Kristin Hsieh, MD; Alexandra Elena Hotca, MD; Daniel R. Dickstein, MD; Eric J. Lehrer, MD; Celina Hsieh, MD; Vishal Gupta, MD; Kunal K. Sindhu, MD; Jerry T. Liu, MD; Samuel H. Reed, PA-C; Arpit Chhabra, MD; Krzysztof Misiukiewicz, MD; Scott Roof, MD; Mohemmed Nazir Kahn, MD; Diana Kirke, MD; Mark Urken, MD; Marshall Posner, MD; Eric Genden, MD; Richard L. Bakst, MD

Advances in Radiation Oncology (Apr 2024)

Adjuvant Reirradiation With Proton Therapy in Head and Neck Squamous Cell Carcinoma

Kristin Hsieh, MD,
Alexandra Elena Hotca, MD,
Daniel R. Dickstein, MD,
Eric J. Lehrer, MD,
Celina Hsieh, MD,
Vishal Gupta, MD,
Kunal K. Sindhu, MD,
Jerry T. Liu, MD,
Samuel H. Reed, PA-C,
Arpit Chhabra, MD,
Krzysztof Misiukiewicz, MD,
Scott Roof, MD,
Mohemmed Nazir Kahn, MD,
Diana Kirke, MD,
Mark Urken, MD,
Marshall Posner, MD,
Eric Genden, MD,
Richard L. Bakst, MD

Affiliations

Kristin Hsieh, MD: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
Alexandra Elena Hotca, MD: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
Daniel R. Dickstein, MD: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
Eric J. Lehrer, MD: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
Celina Hsieh, MD: Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island
Vishal Gupta, MD: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
Kunal K. Sindhu, MD: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
Jerry T. Liu, MD: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
Samuel H. Reed, PA-C: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
Arpit Chhabra, MD: New York Proton Center, New York, New York
Krzysztof Misiukiewicz, MD: Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
Scott Roof, MD: Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
Mohemmed Nazir Kahn, MD: Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
Diana Kirke, MD: Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
Mark Urken, MD: Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
Marshall Posner, MD: Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
Eric Genden, MD: Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
Richard L. Bakst, MD: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York; Corresponding author: Richard L. Bakst, MD

Journal volume & issue: Vol. 9, no. 4
p. 101418

Abstract

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Purpose: For patients with head and neck squamous cell carcinoma (HNSCC), locoregional failure and second primary tumors are common indications for adjuvant reirradiation (re-RT). Given an absence of clear consensus on the role of adjuvant re-RT, we sought to assess histopathologic risk factors of patients with HNSCC and their resulting outcomes after adjuvant re-RT with proton therapy. Methods and Materials: We conducted a retrospective analysis of patients with HNSCC who underwent salvage surgery at our institution followed by adjuvant re-RT with proton therapy over 1.5 years. All included patients received prior radiation therapy. The Kaplan-Meier method was used to evaluate locoregional recurrence-free survival and overall survival. Results: The cohort included 22 patients, with disease subsites, including oropharynx, oral cavity, hypopharynx, larynx, and nasopharynx. Depending on adverse pathologic features, adjuvant re-RT to 66 Gy (32% of cohort) or 60 Gy (68%), with (59%) or without (41%) concurrent systemic therapy was administered. The majority (86%) completed re-RT with no reported treatment delay; 3 patients experienced grade ≥3 acute Common Terminology Criteria for Adverse Events toxicity and no patient required enteral feeding tube placement during re-RT. Median follow-up was 21.0 months (IQR, 11.7-25.2 months). Five patients had biopsy-proven disease recurrences a median of 5.9 months (IQR, 3.8-9.7 months) after re-RT. Locoregional recurrence-free survival was 95.2%, 70.2%, 64.8% at 6, 12, and 24 months, respectively. OS was 100%, 79.2%, and 79.2% at 6, 12, and 24 months, respectively. Four patients had osteoradionecrosis on imaging a median of 13.2 months (IQR, 8.7-17.4 months) after re-RT, with 2 requiring surgical intervention. Conclusions: Adjuvant re-RT for patients with HNSCC was well-tolerated and offered reasonable local control in this high-risk cohort but appears to be associated with a risk of osteoradionecrosis. Additional study and longer follow-up could help define optimal patient management in this patient population.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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