Patterns of local-regional recurrence after conformal and intensity-modulated radiotherapy for head and neck cancer
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RESEARCH
Open Access
Patterns of local-regional recurrence after conformal and intensity-modulated radiotherapy for head and neck cancer Safora Johansen1,2*, Mathilde H. Norman1, Einar Dale1, Cecilie D. Amdal1, Torbjørn Furre1, Eirik Malinen3,4 and Jan F. Evensen1
Abstract Aim: To evaluate the patterns of loco-regional recurrences in head and neck cancer patients Methods: Twenty-six out of 112 patients treated with primary or postoperative 3D CRT or IMRT for their primary and recurrent disease between 2007 and 2013 were included. The CT images of recurrent disease were rigidly registered with the primary CT images for each patient. To assess overlaps and overlap localization, the recurrence volume overlapping with the primary target volume was identified. For relapses occurring in the regional lymph nodes, the epicenter distance in recurrences and primary volumes and dose in recurrences were also identified. The recurrences were defined as in-field, marginal or out-of-field. Results: The majority of the failures occurred within 1 year after completed primary treatment. The dose differences in recurrence volume were not statistically significant when patients were treated with IMRT or 3D CRT. Recurrence in 15/26 of the included patients occurred in the regional lymph nodes located fully or partly inside the primary target volume or the elective lymph node region. The majority of recurrences were recognized as in-field, independent of the primary treatment. Conclusion: Recurrence in the majority of the patients occurred in the regional lymph nodes located in high dose area. The cause of recurrence may be due to inadequate total dose in the primary treatment and/or lack of optimal primary diagnosis leading to inadequate primary target delineation. Keywords: Head and neck cancer, Radiotherapy, Radiotherapy technique, Regional lymph node, Recurrence, Relapse
Introduction The incidence of oral cavity/pharynx and larynx cancer in Europe was estimated to 100,000 and 40,000, respectively, in 2012 [1]. In Norway, 800 patients were diagnosed with head and neck cancer (HNC) in 2014, representing 2.5% of the total incidence of malignant disease [2]. Management of HNC is multi-disciplinary; surgery, radiotherapy (RT) with or without concomitant * Correspondence: [email protected] 1 Department of oncology, Division of cancer Medicine, Surgery and Transplantation (KKT), Oslo University Hospital-Radium hospital, Montebello, 0310 Oslo, Norway 2 Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Oslo, Norway Full list of author information is available at the end of the article
chemotherapy. High dose RT (prescribing doses typically of 70 Gy) is necessary to achieve cure, but may result in side effects. The employment of three-dimensional conformal radiotherapy (3D CRT) and intensity-modulated radiotherapy (IMRT) have permitted treatment largely conforming to the disease extensions for the individual patient [3–6]. However, each year, 30–50% of patients with locally advanced HNC, experien
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