Evidence map›Paper›PMID 40269897›Full record

ArticleRadiation oncology (London, England)2025

Combined Spatial and Dosimetric Recurrence Pattern Analysis in Head and Neck Squamous Cell Carcinoma Following Postoperative (Chemo)radiotherapy.

Philipp Schröter, Hoi Hin Lau, Florian Stritzke, Henrik Franke, Katharina Weusthof, Sebastian Regnery, Lukas Bauer, Maximilian Deng, Katharina Dvornikovich, Anna Hofmann and 9 more

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In one paragraph

Article in Radiation oncology (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Philipp SchröterDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany. philipp.schroeter@med.uni-heidelberg.de.
Hoi Hin LauDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Florian StritzkeDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Henrik FrankeDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Katharina WeusthofDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Sebastian RegneryDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Lukas BauerDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Maximilian DengDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Katharina DvornikovichDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Anna HofmannDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Lars WesselDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Karl SemmelmayerDepartment of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Julius MoratinDepartment of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Oliver RistowDepartment of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Jürgen HoffmannDepartment of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Peter PlinkertDepartment of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Gerhard DyckhoffDepartment of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Jürgen DebusDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Thomas HeldDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAdvancements in nodal staging for head and neck squamous cell carcinoma (HNSCC) have prompted radiotherapy de-escalation trials to reduce irradiation of electively treated neck regions, with the goal of improving treatment tolerability. While volumetric de-escalation has shown promise in definitive radiotherapy of HNSCC, limited data exist regarding its safety in the postoperative treatment setting. This study aimed to assess dose-level-specific locoregional recurrence patterns following standard postoperative (chemo)radiotherapy in a mixed HNSCC cohort to inform risk-adaptive radiotherapy strategies. MATERIALS AND

methodsWe retrospectively reviewed 203 HNSCC patients (75% HPV-negative, 25% HPV-positive) treated with curative intent postoperative (chemo)radiotherapy from 2017 to 2021. Recurrence imaging was co-registered with planning CT, and recurrent tumor volumes were dosimetrically compared to the target volume dose and spatially analyzed using a center-of-mass-based approach. We classified five recurrence types: A (central high-dose), B (peripheral high-dose), C (central intermediate- or low-dose), D (peripheral intermediate- or low-dose), and E (extraneous dose).

resultsWith a median follow-up of 39.7 months, the three-year local, regional, and distant control of HPV-negative HNSCC were 84%, 87%, and 87%, respectively. Of 56 recurrences, 17 were local, 13 regional, 3 locoregional, 9 combined local/regional with concomitant distant failure, and 14 distant only. Of 40 analyzed recurrences, we identified 47.5% as type A/B, 5% as type C/D intermediate-dose, and 20% as type E, half of which were secondary cancers. Among the 27.5% (11/40) type C/D low-dose recurrences in the elective target volume, 15% (6/40) were true nodal failures, resulting in an overall elective neck failure rate of 3% (6/203).

conclusionThe predominance of high-dose recurrences suggests that biological tumor resistance is a key driver of treatment failure, highlighting the necessity to refine postoperative risk stratification and integrate tumor biology into dose escalation decisions. The low incidence of isolated nodal recurrences in electively treated neck regions supports the feasibility of volumetric de-escalation of postoperative radiotherapy. This approach might not only be feasible for HPV-associated oropharyngeal cancers but also for HPV-negative tumors, provided that accurate nodal staging has been conducted.

Indexed as

ChemoradiotherapyHead and Neck NeoplasmsNeoplasm Recurrence, LocalSquamous Cell Carcinoma of Head and NeckAdultAgedAged, 80 and overFemaleHumansMaleMiddle AgedRadiotherapy DosageRadiotherapy Planning, Computer-AssistedRetrospective StudiesDosimetric analysisHead and neck cancerLocal controlOral cavity cancerPostoperative radiation therapyRadiotherapy de-escalationRecurrence patterns

Identifiers

PMID40269897
PMCPMC12020044

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