前列腺癌调强放疗的治疗方案比较

目的 通过对前列腺癌调强放疗的多种布野方案比较，确定符合临床要求的最佳方案。方法 对8例前列腺癌患者采用调强放疗方案，处方总剂量76Gy。共设计7个计划，其中共面布野方案5个，分别为5、6、7、9野均匀分布和7野非均匀分布；非共面布野方案2个，分别为5、7野冠状交角照射。分别比较它们的剂量分布、剂量体积直方图、适形度指数等指标。结果 所有7个共面和非共面计划的计划靶区剂量分布无明显差别，非共面计划比共面计划降低了直肠D59(50％体积所受剂量)剂量23％，但增加了股骨头剂量，膀胱的剂量大致相同；同时非共面计划还延长了治疗时间，摆位较麻烦。对于共面射野计划，当射野数目由5增至7时，增加照射野数目对靶区、直肠和膀胱剂量分布没有改善且会增加治疗时间，但能降低股骨头受量，靶区剂量均匀性、适合度指数提高，5、6野情况大致相同。当射野数由7野增加到9野时，股骨头受量和靶区剂量均匀性、适合度均无改善。结论 5～7野共面调强计划可使前列腺肿瘤获得理想的剂量分布，共面、等角度分布的照射野设计简单、治疗实施效率高。非共面计划射野从5野增加到7野，剂量分布无改善。     

前列腺癌三维适形和调强放疗的初步结果

目的 分析三维适形放疗（3DCRT）和调强放疗（IMRT）前列腺癌的初步疗效和早晚期副反应.方法 36例无远处转移的前列腺癌接受了3DCRT和IMRT,其中35例同时接受内分泌治疗.23例临床靶区包括前列腺或前列腺加精囊,13例先接受盆腔照射然后包括前列腺和精囊.临床靶区的中位剂量为76.0 Gy（52.5～83.0Gy）,盆腔预防性照射中位剂量为45.0Gy（40～50Gy）.结果 3、5年总生存率分别为91%、84%.3、5年癌症相关生存率均为91%.全组早期胃肠道反应≤2级35例,3级1例,无4级反应;早期泌尿系统副反应≤2级34例,3级2例,无4级反应.全组分别有4例1级和3例2级晚期胃肠道反应,无≥3级晚期胃肠道反应;晚期泌尿系统反应发生率低,6例1级,2级1例,3级1例.结论 应用三维适形放疗和调强放疗技术治疗前列腺癌,高剂量放疗是安全的,早期和晚期副反应可接受,未发现严重晚期副反应.     

Systematic review of hypofractionated radiation therapy for prostate cancer

Prostate cancer is the second most prevalent solid tumor diagnosed in men in the United States and Western Europe. Conventionally fractionated external beam radiation therapy (1.8–2.0 Gy/fraction) is an established treatment modality for men in all disease risk groups. Emerging evidence from experimental and clinical studies suggests that the α/β ratio for prostate cancer may be as low as 1.5 Gy, which has prompted investigators around the world to explore moderately hypofractionated radiation therapy (2.1–3.5 Gy/fraction). We review the impetus behind moderate hypofractionation and the current clinical evidence supporting moderate hypofractionated radiation therapy for prostate cancer. Although hypofractionated radiation therapy has many theoretical advantages, there is no clear evidence from prospective, randomized, controlled trials showing that hypofractionated schedules have improved outcomes or lower toxicity than conventionally fractionated regimens. Currently, hypofractionated schedules should only be used in the context of clinical trials. High dose rate brachytherapy and stereotactic body radiation therapy (fraction size 3.5 Gy and greater) are alternative approaches to hypofractionation, but are beyond the scope of this report.     

High-dose-rate intensity modulated brachytherapy with external-beam radiotherapy improves local and biochemical control in patients with high-risk prostate cancer

Purpose Our aim was to report the 8-year outcome of local dose escalation using high-dose-rate conformal brachytherapy combined with external irradiation for patients with high-risk prostate cancer. Material and methods From June 1998 to June 2007, 134 patients with high-risk localized prostate cancer were prospectively enrolled in the study. The median follow-up was 45 months (12-107). Only patients considered as having high-risk criteria were accepted [prostate-specific antigen (PSA) > or =20 ng/ml and/or Gleason >7 and/or stage > or =T3a or two intermediate-risk criteria: PSA 11-19 ng/ml, Gleason 7, stage T2b-c]. The total dose applied by external beam radiotherapy was 46 Gy in 200-cGy daily fractions. High-dose-rate brachytherapy was performed at the end of weeks 1 and 3 of the 5-week radiotherapy course. The doses administered in each application was 1,150 cGy. Any patient free of clinical or biochemical evidence of disease was termed b-NED. Actuarial rates of outcome were calculated by Kaplan.Meier analysis and compared using the log-rank test. Cox regression models were used to establish prognostic factors of the measures of outcome. Results Mean follow-up for the entire group was 45 months (range 12-107). The overall survival (OS) according to Kaplan-Meier estimates was 85% (+/-5) at 5 and 8 years. The 5 and 8 years for biochemical control were 80% (+/-4%) and 73% (+/-7%), respectively, whereas for failure in tumor-free survival (TFS), they were 82% (+/-3) at 5 and 8 years, respectively. The 8-year cause-specific mortality was 10% (+/-4%). The multivariate Cox regression analyses identified the number of poor prognostic factors as independent for biochemical failure. Our report includes only patients considered as high risk, and the 8-year b-NED survival rate was 83% for patients with two intermediate-risk criteria, 78% for patients with one poor prognostic factor, 56% for two and 35% for all three (p = 0.001). There were no urethral strictures and/or urinary incontinence. Gastrointestinal toxicity grade 2 was 7.5%. Conclusions The 8-year results confirm the feasibility and effectiveness of external-beam radiation therapy with conformal high-dose-rate brachytherapy boost for patients with high-risk tumor. The late toxicity rates were low, corroborating the excellent dose conformity.     

Intensity modulated radiation therapy (IMRT) in the management of prostate cancer

Intensity modulated radiation therapy (IMRT) is gaining widespread use in the radiation therapy community. Prostate cancer is the ideal target for IMRT due to the growing body of literature supporting dose escalation and normal tissue limitations. The need for dose escalation and the limits of conventional radiation therapy necessitate precise patient and prostate localization as well as advanced treatment delivery. The treatment of prostate cancer has been dramatically altered by the introduction of technology that can focus on the target while avoiding normal tissue. IMRT is evolving as the treatment of the future for prostate cancer.     

贲门癌调强适形放疗的剂量学研究

目的 用三维治疗计划系统评价调强放疗技术(IMRT)、三维适形技术(3D-CRT)和常规放疗技术在贲门癌应用上的剂量学差异.方法 回顾分析10例贲门癌患者的CT定位图像,利用三维治疗计划系统分别制作IMRT、3D-CRT和模拟常规计划,给予处方剂量4500 cGy.利用剂量体积直方图(DVH图)比较靶区以及危及器官的受照剂量.结果 3D-CRT和IMRT计划与常规计划相比,临床靶区(PTV)的平均剂量均明显提高(P＜0.05),IMRT计划与3D-CRT计划相比,大体肿瘤体积(GTV)的平均剂量增加更加明显(P＜0.05).3D-CRT计划与常规计划相比,在不增加肝脏平均剂量的情况下,减少了受照体积的百分数.IMRT和3D-CRT计划均可明显降低脊髓和心脏的最大受照剂量(P＜0.05),IMRT计划比3D-CRT计划更加减少了脊髓最大受照剂量(P＜0.05).结论 在贲门癌的放射治疗计划剂量分布中,IMRT优于3D-CRT和常规放疗技术.     

IMRT在老年宫颈癌治疗中的应用价值

目的 探讨IMRT在老年宫颈癌初治患者治疗中的临床应用价值。方法 选择2008年1月—2009年1月在我院收治的老年宫颈癌患者60例,其中常规放疗(CRT)组30例,IMRT组30例,比较两组患者的疗效和放疗并发症。结果IMRT组和CRT组近期有效率分别为86.7%和90.0%,差异无统计学意义(P＞0.05);IMRT组1、2年生存率分别为86.7%、73.3%,CRT组1、2年生存率分别为80.0%、63.3%,差异无统计学意义(P＞0.05);IMRT组较CRT组小肠、直肠、膀胱的受照射剂量和体积均明显减少(P＜0.05);近期胃肠道及泌尿系放疗反应IMRT组发生率明显低于CRT组(P＜0.05);远期放射性直肠炎、膀胱炎发生率明显低于CRT组,差异有统计学意义(P＜0.05)。结论 IMRT技术与常规放疗方法相比对老年宫颈癌初治患者是一种更为有效的治疗手段,临床近期疗效满意,放疗并发症明显降低。     

Urinary toxicity after high dose intensity modulated radiotherapy as primary therapy for prostate cancer

Background and purpose

Urinary toxicity plays a major role in the quality of life (QOL) of patients treated with external beam radiotherapy as primary therapy for prostate cancer.In this study we report on:(1) Incidence of acute and late GU toxicity after intensity modulated radiotherapy (IMRT) for prostate cancer at Ghent University Hospital (GUH).(2) Time evolution of pre-IMRT and IMRT-induced acute and late GU toxicity.

Materials and methods

At GUH, 260 patients with a follow-up of ?12 months were treated with IMRT for prostate cancer. The incidence and evolution of GU toxicity were recorded.

Results

Acute grades 3, 2 and 1 GU toxicity occurred in 8%, 42% and 42% of the patients, respectively. Late grades 3, 2 and 1 GU toxicity occurred in 3%, 19% and 40% of the patients, respectively.During therapy baseline grade 1 symptoms increased into grade 2 acute GU toxicity in 48%. After 1 and 2 years, 60% and 70% of the patients, respectively, had less GU symptoms when compared to the pre-treatment status.

Conclusion

IMRT induces mild GU toxicity. There is an improvement in pre-IMRT obstructive miction disorders.     

Five-year biochemical outcome and toxicity with transperineal CT-planned permanent I-125 prostate implantation for patients with localized prostate cancer

Purpose: To report the 5-year prostate-specific antigen (PSA) relapse-free survival outcome and incidence of long-term morbidity for patients with localized prostate cancer treated with CT-planned permanent I-125 prostate implantation using a transperineal technique (TPI).

Methods and Materials: Between 1989–1996, 248 patients with clinically localized prostate cancer were treated with TPI. The median age was 65 years (range: 45–80 years). The clinical stage was T1c in 143 patients (58%), Stage T2a in 102 (41%), and T2b in 3 (1%). Thirty patients (12%) had Gleason scores <6, 158 patients (64%) had Gleason scores of 6, and 60 (24%) had scores ≥7. The median pretreatment PSA was 7 ng/mL (range: 1–58 ng/mL). The median prescribed implant dose was 150 Gy. Patients were characterized as having favorable risk disease if their pretreatment PSA level was ≤10.0 ng/mL and Gleason score ≤6; those with one and two adverse prognostic features (PSA > 10 ng/mL and Gleason score >6) were classified as having intermediate and unfavorable risk disease, respectively. PSA relapse was defined according to the American Society of Therapeutic Radiation Oncology Consensus Statement, and toxicity was scored according to the Radiation Therapy Oncology Group morbidity scoring scale. The median follow-up was 48 months (range: 12–126 months).

Results: Thirty-eight patients (15%) developed a PSA relapse, and the overall 5-year PSA relapse-free survival (PRFS) rate was 71%. The 5-year PRFS rates for favorable-risk (n = 146), intermediate-risk (n = 85), and unfavorable-risk (n = 17) patients were 88%, 77%, and 38%, respectively (p < 0.0001). The 5-year PRFS rates among patients treated with a 2-month course of neoadjuvant androgen deprivation (NAAD) prior to TPI compared to patients treated with TPI only were 100% and 77%, respectively (p = 0.03). Multivariate analysis identified pretreatment PSA > 10 ng/mL and Gleason score >6 as independent predictors for biochemical relapse after TPI. The 5-year actuarial likelihood of late Grade 2 urinary toxicity was 41%. The 5-year likelihood of urethral stricture development was 10%, and the median time to stricture development was 18 months. One patient (0.4%) in the early phase of this clinical experience developed a Grade 4 urethral complication. The actuarial incidence of late Grade 2 rectal bleeding was 9%. One patient (0.4%) developed a Grade 4 rectal complication.

Conclusions: Especially for favorable risk disease, the 5-year biochemical outcome with this approach was excellent and appears to be comparable to other therapeutic interventions. Grade 2 urinary symptoms were common in these patients but gradually resolved in most. Improved treatment planning approaches that further constrain the urethral dose without compromising the target volume dose will likely decrease the incidence of Grade 2 and 3 urinary symptoms after TPI.     

Localized volume effects for late rectal and anal toxicity after radiotherapy for prostate cancer

PURPOSE: To identify dosimetric parameters derived from anorectal, rectal, and anal wall dose distributions that correlate with different late gastrointestinal (GI) complications after three-dimensional conformal radiotherapy for prostate cancer. METHODS AND MATERIALS: In this analysis, 641 patients from a randomized trial (68 Gy vs. 78 Gy) were included. Toxicity was scored with adapted Radiation Therapy Oncology Group/European Organization for the Research and Treatment of Cancer (RTOG/EORTC) criteria and five specific complications. The variables derived from dose-volume histogram of anorectal, rectal, and anal wall were as follows: % receiving > or =5-70 Gy (V5-V70), maximum dose (Dmax), and mean dose (D(mean)). The anus was defined as the most caudal 3 cm of the anorectum. Statistics were done with multivariate Cox regression models. Median follow-up was 44 months. RESULTS: Anal dosimetric variables were associated with RTOG/EORTC Grade > or =2 (V5-V40, D(mean)) and incontinence (V5-V70, D(mean)). Bleeding correlated most strongly with anorectal V55-V65, and stool frequency with anorectal V40 and D(mean). Use of steroids was weakly related to anal variables. No volume effect was seen for RTOG/EORTC Grade > or =3 and pain/cramps/tenesmus. CONCLUSION: Different volume effects were found for various late GI complications. Therefore, to evaluate the risk of late GI toxicity, not only intermediate and high doses to the anorectal wall volume should be taken into account, but also the dose to the anal wall.     

Grading-system-dependent volume effects for late radiation-induced rectal toxicity after curative radiotherapy for prostate cancer

PURPOSE: To assess the association between the dose distributions in the rectum and late Radiation Therapy Oncology Group and the European Organisation for Research and Treatment of Cancer (RTOG/EORTC), Late Effects of Normal Tissue SOMA, and Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 graded rectal toxicity among patients with prostate cancer treated with RT. METHODS AND MATERIALS: Included in the study were 124 patients who received three-dimensional conformal RT for prostate cancer to a total dose of 70 Gy in 2-Gy fractions. All patients completed questionnaires regarding rectum complaints before RT and during long-term follow-up. Late rectum Grade 2 or worse toxicity, according to RTOG/EORTC, LENT SOMA, and CTCAE v3.0 criteria, was analyzed in relation to rectal dose and volume parameters. RESULTS: Dose-volume thresholds (V40>or=65%, V50>or=55%, V65>or=45%, V70>or=20%, and a rectum volumeor=70 Gy (V70) was most predictive for late Grade 2 or worse rectal toxicity with each of the grading systems. The associations were strongest, however, with use of the LENT SOMA system. CONCLUSIONS: Volume effects for late radiation-induced rectal toxicity are present, but their clinical significance depends on the grading system used. This should be taken into account in the interpretation of studies reporting on radiation-induced rectal toxicity.     

Stereotactic body radiation therapy for prostate cancer: Is the technology ready to be the standard of care?

Prostate cancer is the second most prevalent solid tumor diagnosed in men in the United States and Western Europe. Stereotactic body radiation therapy (SBRT) is touted as a superior type of external beam radiation therapy (EBRT) for the treatment of various tumors. SBRT developed from the theory that high doses of radiation from brachytherapy implant seeds could be recapitulated from advanced technology of radiation treatment planning and delivery. Moreover, SBRT has been theorized to be advantageous compared to other RT techniques because it has a treatment course shorter than that of conventionally fractionated EBRT (a single session, five days per week, for about two weeks vs. eight weeks), is non-invasive, is more effective at killing tumor cells, and is less likely to cause damage to normal tissue. In areas of the US and Europe where there is limited access to RT centers, SBRT is frequently being used to treat prostate cancer, even though long-term data about its efficacy and safety are not well established. We review the impetus behind SBRT and the current clinical evidence supporting its use for prostate cancer, thus providing oncologists and primary care physicians with an understanding of the continually evolving field of prostate radiation therapy. Studies of SBRT provide encouraging results of biochemical control and late toxicity. However, they are limited by a number of factors, including short follow-up, exclusion of intermediate- and high-risk patients, and relatively small number of patients treated. Currently, SBRT regimens should only be used in the context of clinical trials.     

官颈癌治疗后主动脉旁淋巴转移调强放疗剂量学研究及临床观察

目的：探讨调强放射治疗（intensity modulated radiotherapy,IMRT）应用于宫颈癌治疗后主动脉旁淋巴结转移的剂量学特点、治疗效果及在减少并发症方面的价值。方法：选取2005—06—01—2012—12—30临沂市肿瘤医院（65例）和山东省肿瘤医院（51例）接受全程IMRT或适形放疗（conventional radiotherapy,CRT）治疗的116例主动脉旁淋巴结转移的宫颈癌患者。56例宫颈癌治疗后主动脉旁淋巴结转移患者接受全程IMRT,给予PTV剂量（58～69）Gy／（29～30）次,2．0～2．3Gy／次,中位剂量63．5Gy,随机选择10例患者,用三维治疗计划系统进行IMRT和常规放疗（CRT）计划设计,拟给予相同的处方剂量,比较危及器官受照射剂量。随机选择同期接受CRT（60例）患者,比较IMRT和CRT的靶区剂量、疗效、急性和晚期毒副作用及生存率。结果：56例患者均完成全程IMRT,95％的等剂量曲线可以覆盖99％的PTV体积,IMRT与拟行CRT计划比较,IMRT计划中小肠（t=2．958,P=0．016）、肾脏（t=14．438,P〈0．001）和脊髓（t=34．511,P〈0．001）受照射剂量明显降低,靶区剂量明显提高,t=20．924,P〈0．001,IMRT组的急性和慢性毒副作用均明显减少,P〈0．05。两组完全缓解率（x2=11．048,P=0．001）、部分缓解率（x2=5．893,P=0．015）和总有效率（x2=32．251,P〈0．001）比较差异均有统计学意义;1、3和5年生存率比较差异有统计学意义,x2=9．530,P=0．002。结论：IMRT对宫颈癌治疗后主动脉旁淋巴结转移患者可获得理想的剂量分布,邻近危及器官得到保护,临床疗效满意,毒副作用明显减少,有效率提高,生存期明显延长。     

A dosimetric study of polyethylene glycol hydrogel in 200 prostate cancer patients treated with high-dose rate brachytherapy ± intensity modulated radiation therapy

Background and purpose

We sought to analyze the effect of polyethylene glycol (PEG) hydrogel on rectal doses in prostate cancer patients undergoing radiotherapy.

Materials and methods

Between July 2009 and April 2013, we treated 200 clinically localized prostate cancer patients with high-dose rate (HDR) brachytherapy ± intensity modulated radiation therapy. Half of the patients received a transrectal ultrasound (TRUS)-guided transperineal injection of 10 mL PEG hydrogel (DuraSeal™ Spinal Sealant System; Covidien, Mansfield, MA) in their anterior perirectal fat immediately prior to the first HDR brachytherapy treatment and 5 mL PEG hydrogel prior to the second HDR brachytherapy treatment. Prostate, rectal, and bladder doses and prostate–rectal distances were calculated based upon treatment planning CT scans.

Results

There was a success rate of 100% (100/100) with PEG hydrogel implantation. PEG hydrogel significantly increased the prostate–rectal separation (mean ± SD, 12 ± 4 mm with gel vs. 4 ± 2 mm without gel, p < 0.001) and significantly decreased the mean rectal D_{2 mL} (47 ± 9% with gel vs. 60 ± 8% without gel, p < 0.001). Gel decreased rectal doses regardless of body mass index (BMI).

Conclusions

PEG hydrogel temporarily displaced the rectum away from the prostate by an average of 12 mm and led to a significant reduction in rectal radiation doses, regardless of BMI.     

Poorer outcome in Polynesian patients with prostate cancer treated with definitive conformational radiation therapy

Purpose

To compare freedom from biochemical failure (FFBF) of French Polynesian (FP) and Native European (NE) prostate cancer patients after definitive conformal radiotherapy (RT).

Patients and methods

Data were reviewed from medical records of 152 consecutive patients (46 FP and 106 NE) with clinically localised prostate cancer treated with definitive RT. Neoadjuvant androgen deprivation therapy (ADT) was used in 22% of cases. Definition for biochemical failure was a rise by 2 ng/mL or more above the nadir prostate-specific antigen (PSA) level. The median follow-up was 34 months.

Results

In comparison to NE patients, FP patients were younger (p = 0.002) with a higher low-risk proportion (p = 0.06). Probability of 5-year FFBF was 77% in the NE cohort and 58.0% in the FP cohort (p = 0.017). Univariate analysis showed that FP ethnicity was associated with worse prognosis in high-risk tumours (p = 0.004). Cox multivariate analysis showed that factors associated with FFBF were risk category (p < 0.017), and FP origin (p = 0.03), independently of ADT and radiation dose.

Conclusion

FP ethnicity was an independent prognostic factor for biochemical relapse after definitive conformal RT for prostate cancer.     

左侧乳腺癌调强放疗的剂量学研究

目的比较左侧乳腺癌保乳术后调强放疗与常规放疗靶区内剂量均匀性、心脏照射剂量和体积的差异。方法对38例左侧乳腺癌保乳术后,应用逆向调强计划,实施全乳腺两野调强放疗。处方剂量为靶区X线46Gy,瘤床应用常规电子线追加14Gy,总量为60Gy。在同一病例CT片上设计常规全乳切线野照射46Gy。在两种治疗方法剂量体积直方图上比较靶区和心脏受照剂量。应用SPSS11.0软件进行配对T检验,以确定调强放疗是否可改善靶区内剂量均匀度并减少心脏受照剂量。结果调强放疗、常规放疗计划中CTV的D95分别为(4541±34)、(4517±62)cGy,V105%分别为17.5%±17.6%、29.4%±26.3%(P<0.01);V110%分别为0.3%±0.8%和3.7%±8.2%(P=0.010)。心脏的V30分别为4.6%±4.3%、18.8%±12.2%(P<0.01);V40分别为1.4%±2.3%、14.3%±11.0%(P<0.01)。结论左侧乳腺癌保乳术后,调强放疗能改善靶区剂量分布、减少心脏受照剂量和体积。     

The predictive value of 2-year posttreatment biopsy after prostate cancer radiotherapy for eventual biochemical outcome

PURPOSE: To determine the value of a 2-year post-radiotherapy (RT) prostate biopsy for predicting eventual biochemical failure in patients who were treated for localized prostate cancer. METHODS AND MATERIALS: This study comprised 164 patients who underwent a planned 2-year post-RT prostate biopsy. The independent prognostic value of the biopsy results for forecasting eventual biochemical outcome and overall survival was tested with other factors (the Gleason score, 1992 American Joint Committee on Cancer tumor stage, pretreatment prostate-specific antigen level, risk group, and RT dose) in a multivariate analysis. The current nadir + 2 (CN + 2) definition of biochemical failure was used. Patients with rising prostate-specific antigen (PSA) or suspicious digital rectal examination before the biopsy were excluded. RESULTS: The biopsy results were normal in 78 patients, scant atypical and malignant cells in 30, carcinoma with treatment effect in 43, and carcinoma without treatment effect in 13. Using the CN + 2 definition, we found a significant association between biopsy results and eventual biochemical failure. We also found that the biopsy status provides predictive information independent of the PSA status at the time of biopsy. CONCLUSION: A 2-year post-RT prostate biopsy may be useful for forecasting CN + 2 biochemical failure. Posttreatment prostate biopsy may be useful for identifying patients for aggressive salvage therapy.     

High-dose reirradiation with intensity-modulated radiotherapy for recurrent head-and-neck cancer: Disease control,survival and toxicity

Purpose

To evaluate disease control, survival and severe late toxicity after high-dose fractionated reirradiation using intensity-modulated radiotherapy (IMRT) for recurrent head-and-neck cancer.

Materials and methods

Sixty consecutive patients were reirradiated with IMRT between 1997 and 2011. The median prescribed dose was 70 Gy in 35 daily fractions until 2004 and 69.12 Gy in 32 daily fractions thereafter. The median cumulative dose was 132 Gy. Sixty-seven percent of patients had non-metastatic stage IV disease. Surgery prior to reirradiation and concomitant systemic therapy was performed in 13 (22%) and 20 (33%) patients, respectively.

Results

Median follow-up in living patients was 18.5 months. Actuarial 1-, 2- and 5-year locoregional control was 64%, 48% and 32%, respectively. Median overall (OS) and disease-free survival was 9.6 and 6.7 months, respectively. Actuarial 1-, 2- and 5-year OS was 44%, 32% and 22%, respectively. Seventeen (27%) and 2 (3%) patients had grade 3 and 4 acute toxicity, respectively. Cumulative incidence of late grade ? 3 toxicity was 23%, 27% and 66% at 1, 2 and 5 years, respectively. In 4 patients, death was attributed to toxicity: fatal bleeding (n = 2), aspiration pneumonia (n = 1) and skin necrosis (n = 1).

Conclusions

High-dose fractionated reirradiation with IMRT offers 5-year disease control and OS in recurrent head-and-neck cancer for 1/3 and 1/4 patients, respectively. Severe late toxicity after 1–2 and 5 years occurs in 1/4 and 2/3 patients, respectively.