Session Item

Monday
May 09
08:00 - 08:40
Auditorium 11
MRI: From basic to state-of-the-art acquisition protocols
Tufve Nyholm, Sweden
3040
Teaching lecture
Physics
16:25 - 16:50
Why EBRT?
SP-0087

Abstract

Why EBRT?
Authors:

Pierluigi Bonomo1

1Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

Show Affiliations
Abstract Text

In over 60% of cases, the diagnosis of squamous cell carcinoma of the head and neck (SCCHN) occurs at a loco-regionally advanced stage, carrying by itself a suboptimal prognosis with a long-term overall survival rate of about 50%. The predominant pattern of failure is loco-regional: a recurrence in the head and neck after primary treatment is associated with poor outcome and a marked detriment to patients’ quality of life. Only up to a third of patients are amenable to salvage surgery, and up to 50% of the operated ones are at risk of a further disease recurrence, particularly in case of adverse pathologic features such as positive surgical margins or extranodal extension. In last 10 years, the recognition of the strong, independent reduction of risk of death and disease progression carried by a positive human papilloma virus (HPV) status has changed the historical “one-size fits-all approach” of head and neck cancer. The exquisite radio and chemo-sensitivity of HPV positive oropharyngeal cancer has allowed to decrease the rate of loco-regional failures in comparison with HPV negative counterparts, with a proportionally higher competing risk of distant metastases. However, still today loco-regional recurrence remains the most frequent event of disease progression for the overall population with SCCHN. Other than salvage surgery, the only therapeutic option which retains a potential curative intent is re-irradiation.

The aim of this presentation will be to report on the role of EBRT in this scenario, according to the following outine

- analysis of the pattern of failure of HNSCC after definitive chemo-radiotherapy, addressing "historical" data (such as the MACH-NC and MARCH meta-analyses) and providing an insight on modern studies with prevalent HPV population

- focus on the key aspects related to patient selection criteria for re-irradiation, overall the most relevant issue faced in clinical practice

- focus on the evidence in support of re-irradiation, analyzing the available data on IMRT, SBRT and protons

- report on the available evidence and future perspectives on the integration of systemic therapies and re-irradiation