Investigation of radiation therapy effectiveness and safety of recurrent head and neck squamous cell carcinoma

Purpose/Objective: In the latest decade increase the amount of publications, where are shown the results of external beam radiotherapy (EBRT) and high dose brachytherapy (HDR-BRT) in the treatment of recurrent head and neck squamous cell carcinoma (HNSCC), but there are no studies, where EBRT and HDR-BRT were compared. The aim of this study is to evaluate and to compare the efficacy and toxicity of the three-dimensional radiotherapy (3D-RT) and high-dose-rate brachytherapy (HDR-BRT) in the treatment of recurrent HNSCC. Materials and Methods: From October 2008 to February 2013, prospective clinical study was conducted in our clinics. 64 patients with HNSCC relapse were randomly assigned, in a 1:1 ratio, to receive 3D-RT (50 Gy/25 fractions), either received HDR-BRT (30 Gy/12fractions). All patients were evaluated for eligibility and the following selection criteria was applied: 1) histologically confirmed HNSCC relapse; 2) relapse identified in an area which had been irradiated during primary EBRT with a total dose of ≥50 Gy; 3) no bony invasion by the tumor; 4) no distant metastases; 5) no late grade 3 - 4 toxicity after the primary EBRT. One patient in 3D-RT group after randomization was removed from analysis due to myocardial infarction. The median time between the primary EBRT and reirradiation was 15 months (interval 3-26.1 months); administered median total dose was 66 Gy (interval 50-70 Gy). All patients completed the planned reirradiation, 15 (48.4%) patients in 3DRT group and 16 (50%) patients in HDR-BRT group received surgical treatment prior to the reirradiation, none of the patients received the chemotherapy. Results: The median overall survival (OS) of patients treated with HDRBRT was 33.4 months, and 1 and 2-year OS was 74% and 67%, respectively. The median OS of patients treated with 3D-RT was 11.9 . [...]