POSSIBILITIES OF REIRRADIATION IN PATIENTS WITH RECURRENT SQUAMOUS CELL CARCINOMA OF HEAD AND NECK

Locoregional recurrence  is the most frequent cause of death of patients  with SCCHN. At present day clear guidance on the irradiation volume, total dose and timing of radiation re-treatment of these patients  are missing. 20 patients  with histologically confirmed locoregional recurrence  of HNSCC, received reirradiation. Median time after primary radiotherapy course was 37 months.  The treatment volumes and total doses were formed as follows: GTV (primary lesion and involved lymph nodes, delineated on CT, MRI and ¹⁸F-FDG PET-CT)+CTV (0,5–1,0 cm) + PTV (0,3–0,5 cm) was treated  to the total dose equivalent  to 66–70 Gy of conventional  fractionation,  the upper  neck (if indicated,  levels I–III+PTV 0,5 cm) to 60 Gy, the lower neck (if indicated,  levels IV–V+PTV 0,5 cm) — equivalent to 50 Gy. Single doses to these volumes were 2,14–2,21 Gy, 2,0 Gy and 1,8 Gy, respectively. Treatment was planned using IMRT and VMAT techniques with SIB (Simultaneously Integrated Boost). Daily positioning  inaccuracy was less than 3 mm at lymph nodes PTV and less than 1 mm in OARs of CNS and optic pathways. 19 of 20 patients  received full course of radiation therapy without a break. Radiation toxicity manifested with grade 2 oral and pharyngeal mucositis and grade 2 radiation epidermitis. Relief time of radiation mucositis and dermatitis was the same to primary radiotherapy course. Oneyear OS was 48%. Using technique of SIB with IMRT and VMAT during curative reirradiation of recurrent HNSCC is available with maintaining  satisfactory tolerability.

1. Blanchard P., Baujat B., Holostenco V. et al., Radiother. Oncol., 2011, vol. 100, рр. 33–40.

2. Goodwin W. J. Jr., Laryngoscope, 2000, vol. 110, Suppl. 93, рр. 1–18.

3. Janot F., de Raucourt D., Benhamou E. et al., J. Clin. Oncol., 2008, vol. 26, рр. 5518–5523.

4. Vermorken J. V., Mesia R., Rivera F. et al., N. Engl. J. Med., 2008, vol. 359, рр. 1116–1127.

5. Duprez F., Madani I., Bonte K. et al., Radiother. Oncol., 2009, vol. 93, рр. 563–569.

6. Strojan P., Corry J., Eisbruch A. et al., Head Neck, 2015, vol. 37 (1), рр. 134–150.

7. Choe K. S., Haraf D. J., Solanki A. et al., Cancer, 2011, vol. 117, рр. 4671–4678.

8. Tanvetyanon T., Padhya T., McCaffrey J. et al., J. Clin. Oncol., 2009, vol. 27, рр. 1983–1991.

9. Kharofa J., Choong N., Wang D. et al., Int. J. Radiat. Oncol. Biol. Phys., 2012, vol. 83, рр. 690–695.

10. Daisne J. F., Duprez T., Weynand B. et al., Radiology, 2004, vol. 233, рр. 93–100.

11. Wang K., Heron D. E., Clump D. A. et al., Radiother. Oncol., 2013, vol. 106, рр. 90–95.

12. Hamoir M., Ferlito A., Schmitz S. et al., Oral. Oncol., 2012, vol. 48, рр. 203–210.

13. Flach G. V., Broglie M. A., van Schie A. et al., Oral Oncol., 2012, vol. 48, рр. 85–89.

14. Li J., Xiao Y., Frontiers in Oncology, 2013, vol. 3, рр. 1–6.

15. Clausen M. M., Radiation Oncology, 2013, vol. 8, article 262, 9 p.

16. Allen B. J., Bezak E., Marcu L. G., BioMed. Research International, 2013, vol. 2013, Article ID 749203, 9 p.

17. Chandrasekaran S., The Scientific World Journal, 2013, vol. 2013, Article ID 796029, 12 p.

18. Beyer T., Townsend D. W., Brun T. et al., Journal of Nuclear Medicine, 2000, vol. 41, No. 8, рр. 1369–1379.

19. Thorwarth D., Geets X., Paiusco M., Radiotherapyand Oncology, 2010, vol. 96, No. 3, рр. 317–324.

20. Spencer S. A., Harris J., Wheeler R. H. et al., Head Neck, 2008, vol. 30, рр. 281–288.

21. Watkins J. M., Shirai K. S., Wahlquist A. E. et al., Head Neck, 2009, vol. 31, рр. 493–502.

22. Choe K. S., Haraf D. J., Solanki A. et al., Cancer, 2011, vol. 117, рр. 4671–4678.

23. Shikama N., Kumazaki Y., Tsukamoto N. et al., Jpn. J. Clin. Oncol., 2013, vol. 43, рр. 154–160.