Salvage Reirradiaton With Stereotactic Body Radiotherapy for Locally Recurrent Head-and-Neck Tumors

• Published in: International journal of radiation oncology, biology, physics Vol. 81; no. 1; pp. 104 - 109
• Main Authors: Cengiz, Mustafa, M.D, Özyiğit, Gökhan, M.D, Yazici, Gözde, M.D, Doğan, Ali, M.S, Yildiz, Ferah, M.D, Zorlu, Faruk, M.D, Gürkaynak, Murat, M.D, Gullu, Ibrahim H., M.D, Hosal, Sefik, M.D, Akyol, Fadil, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2011; Elsevier
• Subjects: Adult; Aged, 80 and over; ARTERIES; Biological and medical sciences; BLOOD VESSELS; BODY; Carcinoma - mortality; Carcinoma - pathology; Carcinoma - radiotherapy; Carcinoma - surgery; Carcinoma, Squamous Cell; CARCINOMAS; CARDIOVASCULAR SYSTEM; CAROTID ARTERIES; Carotid artery blow-out; Carotid Artery Diseases - etiology; Carotid Artery Diseases - mortality; COMPUTERIZED TOMOGRAPHY; DIAGNOSTIC TECHNIQUES; DIGESTIVE SYSTEM; DISEASE INCIDENCE; Disease-Free Survival; DISEASES; DOSES; Ent and stomatology; Female; HEAD; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Head and Neck Neoplasms - surgery; Hematology, Oncology and Palliative Medicine; Hemorrhage - etiology; Hemorrhage - mortality; Humans; Male; Medical sciences; MEDICINE; Middle Aged; MORTALITY; NECK; Neoplasm Recurrence, Local - surgery; NEOPLASMS; Neoplasms, Squamous Cell - mortality; Neoplasms, Squamous Cell - pathology; Neoplasms, Squamous Cell - radiotherapy; Neoplasms, Squamous Cell - surgery; NMR IMAGING; NUCLEAR MEDICINE; ORGANS; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; PHARYNX; RADIATION DOSES; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; Radiosurgery - methods; RADIOTHERAPY; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrent head-and-neck tumor; Reirradiation; RESPIRATORY SYSTEM; Retreatment - methods; Salvage Therapy - methods; Squamous Cell Carcinoma of Head and Neck; Stereotactic body radiotherapy; Syndrome; THERAPY; TOMOGRAPHY; Tumor Burden; Tumors; Young Adult; Reirradiation; Stereotactic body radiotherapy; Recurrent head-and-neck tumor; Carotid artery blow-out; Human; Relapse; Prognosis; Radiosurgery; Malignant tumor; Radiotherapy; Treatment; Carotid; ENT disease; Head and neck cancer; Salvage treatment; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2010.04.027

Purpose In this study, we present our results of reirradiation of locally recurrent head-and-neck cancer with image-guided, fractionated, frameless stereotactic body radiotherapy technique. Methods and Materials From July 2007 to February 2009, 46 patients were treated using the CyberKnife (Accuray, Sunnyvale, CA) at the Department of Radiation Oncology, Hacettepe University, Ankara, Turkey. All patients had recurrent, unresectable, and previously irradiated head-and-neck cancer. The most prominent site was the nasopharynx (32.6%), and the most common histopathology was epidermoid carcinoma. The planning target volume was defined as the gross tumor volume identified on magnetic resonance imaging and computed tomography. There were 22 female and 24 male patients. Median age was 53 years (range, 19–87 years). The median tumor dose with stereotactic body radiotherapy was 30 Gy (range, 18–35 Gy) in a median of five (range, one to five) fractions. Results Of 37 patients whose response to therapy was evaluated, 10 patients (27%) had complete tumor regression, 11 (29.8%) had partial response, and 10 (27%) had stable disease. Ultimate local disease control was achieved in 31 patients (83.8%). The overall survival was 11.93 months in median (ranged, 11.4 – 17.4 months), and the median progression free survival was 10.5 months. One-year progression-free survival and overall survival were 41% and 46%, respectively. Grade II or greater long-term complications were observed in 6 (13.3%) patients. On follow-up, 8 (17.3%) patients had carotid blow-out syndrome, and 7 (15.2%) patients died of bleeding from carotid arteries. We discovered that this fatal syndrome occurred only in patients with tumor surrounding carotid arteries and carotid arteries receiving all prescribed dose. Conclusions Stereotactic body radiotherapy is an appealing treatment option for patients with recurrent head-and-neck cancer previously treated with radiation to high doses. Good local control with considerable 1-year survival is achieved with a relatively high rate of morbidity and related mortality.