Curative high-dose reirradiation for patients with recurrent head and neck adenoid cystic carcinomas: outcomes and analysis of patterns of failure

Abstract

Background

To investigate the outcomes of patients who underwent curative reirradiation (reRT), with intensity-modulated radiation therapy (IMRT) or proton therapy (PT) for unresectable recurrent or second primary head and neck adenoid cystic carcinoma (HNACC).

Methods

Ten patients, mostly KPS 90%, were reirradiated (3/10 with IMRT and 7/10 with PT) at a median maximum dose to the CTV of 64.2 Gy from July 2011 to November 2021. Locations at the time of reRT were mainly the sinus (4/10) and the salivary glands (including the parotid and submandibular gland, 3/10). CTCAEv5 was used to assess acute and late toxicities. Follow-up was the time between the end of reRT and the date of last news.

Results

The median time between the two irradiations was 53.5 months (IQR: 18–84). After a median follow-up of 26 months (range, 12.5–51.8 months), six patients had developed a locoregional recurrence (LR), of which four occurred within the previously irradiated volume. Two and three-year locoregional failure-free survival (LFFS) and overall survival (OS) were 55.6% [95%CI: 31–99.7%], and 41% [18.5–94%] and 66.7% [42–100%] and 44.4% [21.4–92.3%], respectively. LFFS and OS were significantly better in the subgroup of sinus tumors (p = .013) and the subgroup of patients re-irradiated more than two years after the first course of irradiation (p = .01). Seven patients had impairments before the start of reRT, including hearing impairment (3/10) and facial nerve impairment (3/10). The most severe late toxicities were brain necrosis (2/10), osteoradionecrosis (1/10) and vision decreased (1/10).

Conclusion

Curative reRT for HNACC is possible for selected cases, but the LR rate in the irradiated field and the risk of severe toxicity remain high. Improved selection criteria and more carefully defined target volumes may improve outcome in these patients. A further study including larger cohort of patients would be useful to confirm these results.

Keywords:

• Adenoid cystic carcinoma
• reirradiation
• proton therapy
• head and neck neoplasms

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, [AB], upon reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Mathilde Mahé

Mathilde Mahé, MD, is a 4-year radiation oncology resident in the Paris region.

Arnaud Beddok

Arnaud Beddok, MD, M.Sc., serves as a physician in Institut Curie’s radiotherapy department for three years. His primary focus lies on re-irradiation issues, with a doctoral study on re-irradiation in head and neck cancer.

Farid Goudjil

Farid Goudjil, M.Sc., directs the physics at Institut Curie’s proton therapy center. His expertise includes proton therapy for Hodgkin’s disease, intracranial tumors, and proton re-irradiation.

Catherine Ala Eddine

Catherine Ala Eddine, MD, is a radiologist at Institut Curie with a specialization in HNC imaging.

Stéphanie Bolle

Stéphanie Bolle, MD, is a radiation oncologist at Gustave Roussy, emphasizing skull base tumors using proton therapy.

Laurence Champion

Laurence Champion, MD, is a nuclear physician at Institut Curie, specializes in HNC imaging and heads the nuclear medicine department.

Loïc Feuvret

Loïc Feuvret, MD, practices as a radiation oncologist, focusing on skull base tumors using proton therapy.

Philippe Herman

Philippe Herman, MD, PhD, is a HNC surgery professor and leads the HN surgery department at Lariboisière Hospital.

Sofia Zefkili

Sofia Zefkil, PhD, works as a physicist at Institut Curie, concentrating on HNC treatments.

Olivier Choussy

Olivier Choussy, MD, PhD, oversees the HN surgery department at Institut Curie.

Christophe Le Tourneau

Christophe Le Tourneau, MD, PhD, heads the clinical trial department at Institut Curie and is professor of medical oncology at UVSQ.

Remi Dendale

Remi Dendale, MD, M.Sc., manages Institut Curie’s proton therapy center, specializing in ophthalmic tumor treatment using proton therapy.

Irene Buvat

Irene Buvat, Ph.D., leads the Translational Imaging Laboratory in Oncology at Institut Curie and is globally acknowledged for her expertise in PET, particularly in predicting head and neck cancer recurrence post re-irradiation.

Elisabeth Sauvaget

Elisabeth Sauvaget, MD, supervises the HN surgery department at Saint Joseph Hospital.

Gilles Créhange

Gilles Créhange, MD, Ph.D., heads Institut Curie’s radiotherapy department across its Paris, Saint-Cloud, and Orsay sites. He’s internationally recognized for digestive and urological cancer treatments, with profound knowledge in recurrent prostate cancer re-irradiation via brachytherapy.

Valentin Calugaru

Valentin Calugaru, MD, Ph.D., leads the radiotherapy department at Institut Curie's Paris location, with a specialization in HNC management, particularly through proton therapy.