Shlomo Koyfman, MD, associate staff, radiation oncology, Cleveland Clinic, discusses reirradiation options for patients with head and neck cancer.

Before a physician consents to administer reirradiation, every patient should be run through a recursive partitioning analysis algorithm to get an accurate sense of their expected outcome, explains Koyfman. By doing this, it will better inform both the patient and the physician of the risks and benefits of treatment.

There are now 2 ways to reirradiate patients, with intensity-modulated radiation therapy and stereotactic body radiotherapy, with data showing similar safety and efficacy for both.

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Dr. Koyfman on Reirradiation Options for Head and Neck Cancer

Shlomo Koyfman, MD, associate staff, Radiation Oncology, Cleveland Clinic, discusses informing patients of reirradiation as a treatment for head and neck cancer.

Researchers at 8 institutions evaluated intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) to determine outcomes in the reirradiation setting for recurrent head and neck cancer.

With this study, there is now more information to better equip patients to make decisions about their treatment options, explains Koyfman. In addition to elaborating on what the modern outcomes are, being able to provide those prognostic subgroups is going to change the way physicians discuss reirradiation with their patients.

Dr. Koyfman on Informing Patients of Reirradiation for Head and Neck Cancer

Shlomo Koyfman, MD, associate staff, radiation oncology, Cleveland Clinic, discusses intensity-modulated radiation therapy (IMRT) and stereotactic body radiotherapy (SBRT) reirradiation for patients with head and neck cancer.

There are 2 different ways to conduct reirradiation, explains Koyfman. There is IMRT-based reirradiation, which is usually for 6 or 7 weeks, and there is SBRT, which is high doses of only a few treatments.

When compared, it was determined that the safety of both were better than previously thought. However, this comparison seemed to suggest that the patients who were living longer seemed to be the group who received IMRT reirradiation.

Shlomo Koyfman, MD, associate staff, radiation oncology, Cleveland Clinic, discusses intensity-modulated radiation therapy (IMRT) and stereotactic body radiotherapy (SBRT) reirradiation for patients with head and neck cancer.  


Dr. Koyfman on IMRT and SBRT Reirradiation for Head and Neck Cancer

Shlomo Koyfman, MD, associate staff, Radiation Oncology, Cleveland Clinic, discusses advancements in technology and safety of treatments for patients with head and neck cancer. 

There have been many advancements in technology over the past few years, but there was no data to observe the increase in safety, making discussing treatment options for patients with head and neck cancer difficult, states Koyfman.     

                                                                                    More trials need to be investigated to better understand how individual patients will respond to treatments, explains Koyfman.

Shlomo Koyfman, MD, associate staff, Radiation Oncology, Cleveland Clinic, discusses advancements in technology and safety of treatments for patients with head and neck cancer.

Dr. Koyfman on Advancements in Technology and Safety of Treatments in Head and Neck Cancer

Shlomo Koyfman, MD, associate staff, Radiation Oncology, Cleveland Clinic, discusses recent advancements in reirradiation treatment for patients with head and neck cancer.

The reirradiation setting in head and neck cancer has been fortunate enough to see better imaging in the last decade or so, including better PET scanning and MRI scanning. A radiation oncologist treats what he sees, Koyfman explains. Thus, as the ability to see more, and to see more clearly, has gotten so much more advanced, radiation oncologists are able to be more selective about how they treat patients.

Koyfman says he tells his patients that the head and neck is a very "high real estate" area of the body, meaning that a lot of important parts are all located very close to one another. Radiation oncologists are now been able to apply this improved understanding of those structures to the reirradiation setting. Moreover, with more advanced technology and planning, these physicians can be much more careful about how they deposit doses of radiation, and critical structures can now be spared from unnecessary toxicities.

Dr. Koyfman on the Evolution of Reirradiation Treatment in Head and Neck Cancer

Shlomo Koyfman, MD, associate staff, Radiation Oncology, Cleveland Clinic, discusses risk categories that stratified patients in a study evaluating intensity-modulated radiation therapy and stereotactic body radiation therapy to determine outcomes in the reirradiation setting for recurrent head and neck cancer.

An important patient factor assessed in this study was the time it took for a patient to either be diagnosed with a second head and neck cancer or to experience recurrence. If this happened after a 2-year period from the patient's first radiation treatment, it was automatically considered to have a better prognosis.

Of those patients, says Koyfman, if their cancer was removed through surgery and postoperative reirradiation was needed, the 2-year survival was 60%.

On the other hand, the poorer performing patients, whose cancers returned within the 2-year time period or patients were diagnosed with a new cancer in that time, they often had impaired function caused by either prior treatments or their tumors. With the same reirradiation treatment as the better performing patients, this group's 2-year survival was only 16%.

According to Koyfman, these results essentially have oncologists' minds racing to determine which patients should receive more aggressive or risky interventions, and which patients would benefit more from a focus on quality of life. These findings serve to potentially define new standards of care in head and neck cancer, and to assist in the overall decision-making process for patients and physicians.

Dr. Koyfman on Risk Categories in the Reirradiation Setting of Recurrent Head and Neck Cancer

Shlomo Koyfman, MD, associate staff, radiation oncology, Cleveland Clinic, discusses radiation therapy in recurrent head and neck cancer.

Researchers at 8 institutions evaluated intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) to determine outcomes in the reirradiation setting for recurrent head and neck cancer. 

This is a challenging group of patients and the treatment is historically considered high-risk, with significant toxicities. However, all studies regarding this treatment in this patient population are very old, so there is little understanding of modern use, says Koyfman.

The analysis found that cure rates are higher and the toxicities are much lower with IMRT and SBRT than older studies show. This is really important for oncologists to know because many patients are not going currently being offered these treatments due to perceived toxicities, says Koyfman.

The analysis also stratified patients into 3 categories, and found that each group has a significantly different survival rate. This information will be helpful in determining which patients should receive IMRT and SBRT treatment.