Satoshi Imamiya

Prognostic factors of reirradiation for recurrent head and neck cancer.

We analyzed outcomes and prognostic factors to assess the value of reirradiation for recurrent head and neck cancer. Forty-four patients with recurrent squamous-cell carcinoma had undergone external beam reirradiation with cumulative dosing of more than 80 Gy. Six and 38 cases exhibited recurrent stage III and stage IV cancers, respectively. The complete response rate was 32%. Median relapse-free survival time was 4 months, and the 5-year survival was 6%. The major prognostic factor was anatomical location (p < 0.0001). Favorable sites were the nasopharynx, larynx, or oropharynx; unfavorable sites were the oral cavity, nasal cavity, or hypopharynx. Poorly differentiated cancer, no prior surgery, cumulative dose more than 125 Gy, and overlapping field less than 40 cm2 between the initial and reirradiation fields were also favorable factors. Multivariate analysis revealed that anatomical location and overlapping field were significant (0.001 and 0.019, respectively) in relapse-free survival. On exclusion of anatomical location from the analysis, history of prior surgery, and cumulative dose were significant (p = 0.002 and p = 0.023, respectively). Severe late complications occurred in only 1 of 14 (7%) patients followed up for longer than 1 year. Reirradiation would be indicative for nasopharyngeal, oropharyngeal, or laryngeal cancer with small overlapping field, or cancer receiving a cumulative dose more than 125 Gy without prior surgery.

Primary radiotherapy for tongue cancers with a tumor thickness exceeding 1 cm

AbstractBackground. In tongue cancers with a tumor thickness exceeding 1 cm, the validity of radiotherapy as an initial treatment remains controversial. Methods. Between 1979 and 1991, 26 patients with tongue cancer that was 1 cm or more in tumor thickness, and who were without clinical adenopathy underwent interstitial radiotherapy (mean dose, 64 Gy) following external irradiation (mean dose, 35 Gy). Results. In 16 (62%) of the 26 patients control was achieved at the primary site (i.e., no local recurrence till the last follow-up of 41–120 months). In 5 of the 10 patients with recurrence rescue was achieved with a salvage operation. All 3 patients who developed nodal metastases were salvaged. One patient with osteonecrosis and 2 patients with tongue ulcers were operated upon. The whole tongue remained in 13 of the 26 patients and the cumulative 5-year survival was 80%. Conclusion. Radiotherapy is a suitable initial treatment for patients with tongue cancers exceeding 1 cm tumor thickness except for T4 tumors.