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Salvage brachytherapy with or without external beam radiotherapy for oral or oropharyngeal squamous cell carcinomas in previously irradiated areas: carcinologic and toxicity outcomes of 25 patients
Journal of Contemporary Brachytherapy ( IF 1.1 ) Pub Date : 2021-08-24 , DOI: 10.5114/jcb.2021.108594 Pierre-Marie Pialat 1 , Michael Mounie 2 , Fabien Podeur 3 , Frédéric Gassa 1 , Jean-Philippe Suchaud 1 , Bertrand Fleury 4 , Severine Racadot 1 , Anne-Agathe Serre 1 , Pascal Pommier 1
Journal of Contemporary Brachytherapy ( IF 1.1 ) Pub Date : 2021-08-24 , DOI: 10.5114/jcb.2021.108594 Pierre-Marie Pialat 1 , Michael Mounie 2 , Fabien Podeur 3 , Frédéric Gassa 1 , Jean-Philippe Suchaud 1 , Bertrand Fleury 4 , Severine Racadot 1 , Anne-Agathe Serre 1 , Pascal Pommier 1
Affiliation
Introduction
The aim of this study was to assess outcomes of salvage brachytherapy for oral and oropharyngeal squamous cell carcinoma in previously irradiated areas.
Material and methods
This was a retrospective study with 25 patients, treated between 1997 and 2016 for primary (21 cases) or recurrent (4 cases) oral or oropharyngeal squamous cell carcinomas in previously irradiated areas. Fifteen patients were treated with salvage brachytherapy (BT) alone, while 10 patients additionally received external beam radiotherapy (EBRT). Median BT dose was 45 Gy (range, 15-64 Gy), and a median total cumulative dose was 57 Gy (range, 40-70 Gy). Patient age, tumor stage, radiotherapy dose, and time between first treatment and recurrence were analyzed as prognostic factors.
Results
Median overall survival (OS) was 16 months. Patients with less advanced (T1) tumors survived significantly longer (27 vs. 14.5 months, p = 0.046). Five patients experienced a local recurrence, and only one of them was treated with a total dose greater than 60 Gy. In multivariate analysis, patients with T1 lesions had a significant higher OS rate compared to patients with larger lesions (HR = 6.25, 95% CI: 1.18-33.1%, p = 0.031). Patients who received more than 60 Gy had a non-significant, 80% increased OS than those treated with a lower dose (p = 0.072). There was four grade 3 acute toxicities, and no grade 3 or more late toxicities.
Conclusions
Multimodal treatment, including salvage BT, may offer a curative option for selected patients with an acceptable risk of severe toxicity for the treatment of primary or recurrent tumors in previously irradiated areas.
中文翻译：
先前照射区域口腔或口咽鳞状细胞癌的挽救性近距离放射治疗（加或不加外照射）：25 例患者的癌变和毒性结果
引言
本研究的目的是评估抢救性近距离放射治疗对先前照射区域的口腔和口咽鳞状细胞癌的结果。
材料和方法
这是一项对 25 名患者进行的回顾性研究，这些患者在 1997 年至 2016 年期间治疗了先前照射区域的原发性（21 例）或复发性（4 例）口腔或口咽鳞状细胞癌。15 名患者仅接受抢救性近距离放射治疗 (BT)，另外 10 名患者接受了外照射放疗 (EBRT)。中位 BT 剂量为 45 Gy（范围，15-64 Gy），中位总累积剂量为 57 Gy（范围，40-70 Gy）。分析患者年龄、肿瘤分期、放疗剂量和首次治疗与复发之间的时间作为预后因素。
结果
中位总生存期 (OS) 为 16 个月。晚期 (T1) 肿瘤患者的存活时间明显更长（27 个月对 14.5 个月，p = 0.046）。5 例患者出现局部复发，其中只有 1 例接受了总剂量大于 60 Gy 的治疗。在多变量分析中，T1 病变患者的 OS 率显着高于病变较大的患者（HR = 6.25, 95% CI: 1.18-33.1%, p = 0.031）。接受超过 60 Gy 的患者与接受较低剂量治疗的患者相比，OS 增加了 80%，但并不显着（p = 0.072）。有四个 3 级急性毒性，没有 3 级或更多的晚期毒性。
结论
包括挽救性 BT 在内的多模式治疗可能会为具有可接受的严重毒性风险的选定患者提供治疗选择，以治疗先前照射区域的原发性或复发性肿瘤。
更新日期：2021-08-27
The aim of this study was to assess outcomes of salvage brachytherapy for oral and oropharyngeal squamous cell carcinoma in previously irradiated areas.
Material and methods
This was a retrospective study with 25 patients, treated between 1997 and 2016 for primary (21 cases) or recurrent (4 cases) oral or oropharyngeal squamous cell carcinomas in previously irradiated areas. Fifteen patients were treated with salvage brachytherapy (BT) alone, while 10 patients additionally received external beam radiotherapy (EBRT). Median BT dose was 45 Gy (range, 15-64 Gy), and a median total cumulative dose was 57 Gy (range, 40-70 Gy). Patient age, tumor stage, radiotherapy dose, and time between first treatment and recurrence were analyzed as prognostic factors.
Results
Median overall survival (OS) was 16 months. Patients with less advanced (T1) tumors survived significantly longer (27 vs. 14.5 months, p = 0.046). Five patients experienced a local recurrence, and only one of them was treated with a total dose greater than 60 Gy. In multivariate analysis, patients with T1 lesions had a significant higher OS rate compared to patients with larger lesions (HR = 6.25, 95% CI: 1.18-33.1%, p = 0.031). Patients who received more than 60 Gy had a non-significant, 80% increased OS than those treated with a lower dose (p = 0.072). There was four grade 3 acute toxicities, and no grade 3 or more late toxicities.
Conclusions
Multimodal treatment, including salvage BT, may offer a curative option for selected patients with an acceptable risk of severe toxicity for the treatment of primary or recurrent tumors in previously irradiated areas.
中文翻译：
先前照射区域口腔或口咽鳞状细胞癌的挽救性近距离放射治疗（加或不加外照射）：25 例患者的癌变和毒性结果
引言
本研究的目的是评估抢救性近距离放射治疗对先前照射区域的口腔和口咽鳞状细胞癌的结果。
材料和方法
这是一项对 25 名患者进行的回顾性研究，这些患者在 1997 年至 2016 年期间治疗了先前照射区域的原发性（21 例）或复发性（4 例）口腔或口咽鳞状细胞癌。15 名患者仅接受抢救性近距离放射治疗 (BT)，另外 10 名患者接受了外照射放疗 (EBRT)。中位 BT 剂量为 45 Gy（范围，15-64 Gy），中位总累积剂量为 57 Gy（范围，40-70 Gy）。分析患者年龄、肿瘤分期、放疗剂量和首次治疗与复发之间的时间作为预后因素。
结果
中位总生存期 (OS) 为 16 个月。晚期 (T1) 肿瘤患者的存活时间明显更长（27 个月对 14.5 个月，p = 0.046）。5 例患者出现局部复发，其中只有 1 例接受了总剂量大于 60 Gy 的治疗。在多变量分析中，T1 病变患者的 OS 率显着高于病变较大的患者（HR = 6.25, 95% CI: 1.18-33.1%, p = 0.031）。接受超过 60 Gy 的患者与接受较低剂量治疗的患者相比，OS 增加了 80%，但并不显着（p = 0.072）。有四个 3 级急性毒性，没有 3 级或更多的晚期毒性。
结论
包括挽救性 BT 在内的多模式治疗可能会为具有可接受的严重毒性风险的选定患者提供治疗选择，以治疗先前照射区域的原发性或复发性肿瘤。
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