Abstract
Purpose:
To report follow-up data and results of a dose escalation within a prospective phase II protocol scheduling alternating chemoreirradiation for patients with unresectable locoregional recurrence of head and neck cancer after previous curative-intent radiotherapy.
Patients and Methods:
Chemoreirradiation was initially performed in 27 patients by 40.0 Gy split-course reirradiation (re-RT) alternating with three cycles of docetaxel 50 mg/m2 day 1 and cisplatin 15 mg/m2 days 2–5 (first cohort). From 2002 onward, 30 consecutively treated patients received a late-course concomitant boost to 49.6 Gy (second cohort). In July 2008, the survival outcome was analyzed separately for both cohorts and the entire collective (n = 57).
Results:
The Kaplan-Meier estimates for 1- and 2-year overall survival (OS) were 52% and 24%, respectively (median OS 13.4 months). The median time of locoregional control was 9.6 months, and the actuarial 2-year freedom from distant metastasis rate was 55%. The re-RT dose escalation led to a significant improvement of the median OS (17.4 vs. 9.4 months; p = 0.039). Irrespective of the cohort, severe treatment-related toxicities occurred in about one third of patients.
Conclusion:
The treatment results confirm the efficacy and the safety of escalated re-RT doses in this chemoreirradiation protocol.
Zusammenfassung
Ziel:
Berichtet werden das Follow-up einer Phase-II-Studie zur alternierenden Reradiochemotherapie lokoregional rezidivierender, inoperabler HNO-Plattenepithelkarzinome sowie die Auswirkungen der in ihrem Rahmen erfolgten Dosiseskalation.
Patienten und Methodik:
Das ursprüngliche Therapieprotokoll umfasste drei Zyklen Chemotherapie (Docetaxel 50 mg/m2 Tag 1, Cisplatin 15 mg/m2 Tage 2–5) in den Wochen 1, 5 und 7, alternierend mit einer „split-course“-Rebestrahlung bis 40,0 Gy (täglich 2,0 Gy in den Wochen 2 + 3 und 5 + 6). Nach einer Zwischenauswertung im Jahr 2002 (erste Kohorte, n = 27) erhielten weitere 30 Patienten (zweite Kohorte) in Woche 6 einen konkomitanten Boost bis 49,6 Gy. Im Juli 2008 wurden die Studienendpunkte separat für beide Kohorten sowie für das Gesamtkollektiv (n = 57) analysiert.
Ergebnisse:
Im Gesamtkollektiv betrugen das 1- und 2-Jahres-Überleben 52% und 24% (medianes Überleben 13,4 Monate). Die mediane lokoregionale Kontrolle lag bei 9,6 Monaten, und nach 2 Jahren waren 55% der Patienten metastasenfrei. Die Dosiseskalation in der zweiten Kohorte führte zu einem signifikant verbesserten Gesamtüberleben (17,4 vs. 9,4 Monate; p = 0,039). Etwa ein Drittel der Patienten erlitt schwere behandlungsassoziierte Toxizitäten, und dies war unabhängig von der Patientenkohorte.
Schlussfolgerung:
Die Behandlungsergebnisse bestätigen die Effektivität und Sicherheit einer Dosiseskalation im Rahmen dieses Therapieprotokolls.
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Berger, B., Belka, C., Weinmann, M. et al. Reirradiation with Alternating Docetaxel-Based Chemotherapy for Recurrent Head and Neck Squamous Cell Carcinoma. Strahlenther Onkol 186, 255–261 (2010). https://doi.org/10.1007/s00066-010-2082-9
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DOI: https://doi.org/10.1007/s00066-010-2082-9