TY - JOUR
T1 - Recurrent oropharyngeal cancer after organ preserving treatment
T2 - pattern of failure and survival
AU - de Ridder, M.
AU - Gouw, Z. A. R.
AU - Sonke, J. J.
AU - Navran, A.
AU - Jasperse, B.
AU - Heukelom, J.
AU - Tesselaar, M. E. T.
AU - Klop, W. M. C.
AU - van den Brekel, M. W. M.
AU - Al-Mamgani, Abrahim
N1 - Publisher Copyright: © 2016, Springer-Verlag Berlin Heidelberg.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - The objectives is to thoroughly analyze the pattern of failure and oncologic outcome in recurrent oropharyngeal cancer (OPC) after (chemo)radiotherapy and correlate the site of failure to the planned radiation dose. Between January 2010 and April 2014, 57 patients with recurrent OPC after (chemo)radiotherapy were analyzed. Endpoints were pattern of failure and overall survival (OS). Local (LF) and regional failure (RF) were classified as in-field [>50% within gross tumor volume (GTV)], marginal [<50% within GTV but >50% within clinical target volume (CTV)], or out-of-field (>50% outside CTV) recurrences. In the whole group, 70 recurrences were reported. Of the 31 LF, 29 (93.5%) were in-field and 2 (6.5%) were marginal. No out-field LF was reported. Of the 21 RF, 13 RF (62%) were in-field, 6 (28.5%) marginal, and 2 (9.5%) out-of-field recurrences. Forty-three percent of RF was developed in an electively treated neck level, and 2 of them were contralateral. OS at 2 years in recurrent HPV positive, compared to HPV-negative OPC, were 66 and 18%, respectively (p = 0.011). OS was also significantly better in patients that were salvage treatment which was possible (70 vs. 6%, p < 0.001). Median survival after distant failure was 3.6 months. The great majority of LFs were located within the GTV and 43% of RFs developed in an electively treated neck level. The currently used margins and dose recipe and the indication for bilateral nodal irradiation need to be reevaluated. OS was significantly better in recurrent HPV-positive OPC and in patients, where salvage treatment was possible.
AB - The objectives is to thoroughly analyze the pattern of failure and oncologic outcome in recurrent oropharyngeal cancer (OPC) after (chemo)radiotherapy and correlate the site of failure to the planned radiation dose. Between January 2010 and April 2014, 57 patients with recurrent OPC after (chemo)radiotherapy were analyzed. Endpoints were pattern of failure and overall survival (OS). Local (LF) and regional failure (RF) were classified as in-field [>50% within gross tumor volume (GTV)], marginal [<50% within GTV but >50% within clinical target volume (CTV)], or out-of-field (>50% outside CTV) recurrences. In the whole group, 70 recurrences were reported. Of the 31 LF, 29 (93.5%) were in-field and 2 (6.5%) were marginal. No out-field LF was reported. Of the 21 RF, 13 RF (62%) were in-field, 6 (28.5%) marginal, and 2 (9.5%) out-of-field recurrences. Forty-three percent of RF was developed in an electively treated neck level, and 2 of them were contralateral. OS at 2 years in recurrent HPV positive, compared to HPV-negative OPC, were 66 and 18%, respectively (p = 0.011). OS was also significantly better in patients that were salvage treatment which was possible (70 vs. 6%, p < 0.001). Median survival after distant failure was 3.6 months. The great majority of LFs were located within the GTV and 43% of RFs developed in an electively treated neck level. The currently used margins and dose recipe and the indication for bilateral nodal irradiation need to be reevaluated. OS was significantly better in recurrent HPV-positive OPC and in patients, where salvage treatment was possible.
KW - (Chemo)radiation
KW - Aged
KW - Aged, 80 and over
KW - Carcinoma, Squamous Cell/mortality
KW - Female
KW - Follow-Up Studies
KW - HPV
KW - Humans
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Neoplasm Recurrence, Local/diagnostic imaging
KW - Oropharyngeal Neoplasms/mortality
KW - Pattern of failure
KW - Radiotherapy Dosage
KW - Radiotherapy, Intensity-Modulated
KW - Recurrent oropharyngeal cancer
KW - Salvage Therapy
KW - Treatment Failure
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85004115728&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/27942891
UR - http://www.scopus.com/inward/record.url?scp=85004115728&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00405-016-4413-7
DO - https://doi.org/10.1007/s00405-016-4413-7
M3 - Article
C2 - 27942891
SN - 0937-4477
VL - 274
SP - 1691
EP - 1700
JO - European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
JF - European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
IS - 3
ER -