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<p>Advancements in surgical and radiotherapy techniques have enhanced locoregional control (LRC) in head and neck squamous cell carcinoma (HNSCC), yet 30–40% of patients still experience recurrence within 2–3 years. Salvage surgery can result in significant morbidity and often fails to achieve optimal LRC as a standalone treatment. Modern radiotherapy (RT) techniques support highly conformal re-irradiation for small local recurrences with acceptable toxicity. The role of positron emission tomography (PET-CT) based contouring is under evaluation for re-irradiation settings. This retrospective study included patients treated with re-irradiation at a tertiary care center, focusing on those with prior HNSCC in the oral cavity, pharynx, or larynx, who had received radical or adjuvant RT and presented with biopsy-confirmed recurrences or second primary tumors. PET-CT was used for metastatic workup, with rigid image registration on planning CT scan employing a significant 40% SUVmax cut-off for tumor delineation. From January 2019 to June 2022, 85 patients underwent re-irradiation, with a median RT dose of 60&#xa0;Gy (range: 44–66&#xa0;Gy); 32 patients received concurrent chemoradiotherapy (CRT). Treatment planning used the volumetric modulated arc technique (VMAT), with the median Dmax for critical structures ranging from 7&#xa0;Gy to 63&#xa0;Gy. Acute grade 3 or higher mucositis, dysphagia, and odynophagia were observed in up to 23.5% of cases. At a median follow-up of 23 months, the 2-year disease-free survival (DFS) and overall survival (OS) rates were 55.2% and 63.5%, respectively. These promising results support PET-CT contouring-based planning as a potential standard of care in re-irradiation.</p>

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Positron emission tomography directed re-irradiation using volumetric modulated arc technique in recurrent head and neck squamous cell carcinoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月28日

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  • Sambit S. Nanda,
  • Ankita Rungta Kapoor,
  • Ashutosh Mukherji,
  • Ajay Kumar Choubey,
  • Akhil Kapoor,
  • Ajay S. Krishnan,
  • Ninad H. Patil,
  • Aseem Mishra,
  • Satyajit Pradhan

摘要

Advancements in surgical and radiotherapy techniques have enhanced locoregional control (LRC) in head and neck squamous cell carcinoma (HNSCC), yet 30–40% of patients still experience recurrence within 2–3 years. Salvage surgery can result in significant morbidity and often fails to achieve optimal LRC as a standalone treatment. Modern radiotherapy (RT) techniques support highly conformal re-irradiation for small local recurrences with acceptable toxicity. The role of positron emission tomography (PET-CT) based contouring is under evaluation for re-irradiation settings. This retrospective study included patients treated with re-irradiation at a tertiary care center, focusing on those with prior HNSCC in the oral cavity, pharynx, or larynx, who had received radical or adjuvant RT and presented with biopsy-confirmed recurrences or second primary tumors. PET-CT was used for metastatic workup, with rigid image registration on planning CT scan employing a significant 40% SUVmax cut-off for tumor delineation. From January 2019 to June 2022, 85 patients underwent re-irradiation, with a median RT dose of 60 Gy (range: 44–66 Gy); 32 patients received concurrent chemoradiotherapy (CRT). Treatment planning used the volumetric modulated arc technique (VMAT), with the median Dmax for critical structures ranging from 7 Gy to 63 Gy. Acute grade 3 or higher mucositis, dysphagia, and odynophagia were observed in up to 23.5% of cases. At a median follow-up of 23 months, the 2-year disease-free survival (DFS) and overall survival (OS) rates were 55.2% and 63.5%, respectively. These promising results support PET-CT contouring-based planning as a potential standard of care in re-irradiation.