Methods for estimating the site of origin of locoregional recurrence in head and neck squamous cell carcinoma

Strahlenther Onkol. 2012 Aug;188(8):671-6. doi: 10.1007/s00066-012-0127-y. Epub 2012 May 13.


Purpose: Methods to estimate the likely origin of recurrences after radiation therapy for head and neck squamous cell carcinoma are compared.

Methods and materials: A total of 25 patients meeting the following inclusion criteria were randomly selected: curatively intended intensity-modulated radiotherapy planned on a positron emission tomography-computed tomography (PET/CT) scan during the period 2005-2009; squamous cell carcinoma in the oral cavity, pharynx or larynx; complete clinical response followed by locoregional recurrence; and a CT scan at recurrence before any salvage therapy. Exclusion criteria were previous cancer in the area, surgery prior to radiotherapy, or a synchronous cancer. Three methods of estimating focal points of recurrence origin and two volume overlap methods assigning the recurrences to the most central target volumes encompassing at least 50% or 95% of the recurrence volumes were tested. Treatment planning and recurrence scans were rigid and deformable co-registered in order to transfer focal points to the treatment planning scan. Double determinations of all volumes, points, and co-registrations were made.

Results: The volume overlap methods assigned the recurrences to significantly more peripheral target volumes than focal methods (p < 0.0001 for all comparisons of 95% overlap vs. focal methods, p < 0.028 for all comparisons of 50% overlap vs. focal methods). Repeated registrations of the same point had higher reproducibility with deformable registration than with rigid registration (median distance 0.31 vs. 0.35 cm, p = 0.015). No significant differences were observed among the focal methods.

Conclusion: Significant differences between methods were found which may affect strategies to improve radiotherapy based on pattern of failure analyses.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / radiotherapy*
  • Carcinoma, Squamous Cell / surgery
  • Chemoradiotherapy
  • Combined Modality Therapy
  • Dose Fractionation, Radiation
  • Female
  • Head and Neck Neoplasms / diagnostic imaging
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / radiotherapy*
  • Head and Neck Neoplasms / surgery
  • Humans
  • Laryngeal Neoplasms / diagnostic imaging
  • Laryngeal Neoplasms / pathology
  • Laryngeal Neoplasms / radiotherapy
  • Laryngeal Neoplasms / surgery
  • Male
  • Mouth Neoplasms / diagnostic imaging
  • Mouth Neoplasms / pathology
  • Mouth Neoplasms / radiotherapy
  • Mouth Neoplasms / surgery
  • Multimodal Imaging
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / radiotherapy*
  • Neoplasm Recurrence, Local / surgery
  • Neoplasms, Unknown Primary / diagnostic imaging
  • Neoplasms, Unknown Primary / pathology
  • Neoplasms, Unknown Primary / radiotherapy*
  • Neoplasms, Unknown Primary / surgery
  • Otorhinolaryngologic Neoplasms / diagnostic imaging
  • Otorhinolaryngologic Neoplasms / pathology
  • Otorhinolaryngologic Neoplasms / radiotherapy*
  • Otorhinolaryngologic Neoplasms / surgery
  • Pharyngeal Neoplasms / diagnostic imaging
  • Pharyngeal Neoplasms / pathology
  • Pharyngeal Neoplasms / radiotherapy
  • Pharyngeal Neoplasms / surgery
  • Positron-Emission Tomography
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Radiotherapy, Intensity-Modulated / methods*
  • Salvage Therapy
  • Squamous Cell Carcinoma of Head and Neck
  • Tomography, X-Ray Computed
  • Tumor Burden