Gamma knife radiosurgery for recurrent salivary gland malignancies involving the base of skull.
BACKGROUND
The management of skull base recurrence of salivary gland tumors is challenging, because complete surgical resection and fractionated reirradiation are seldom possible. Experience is being gained with radiosurgery for this indication.


METHODS
From 1994-2000, eight patients with 16 skull base recurrences of salivary gland tumors underwent Gamma Knife radiosurgery at the University of California San Francisco. Local freedom from progression (FFP), regional FFP, locoregional FFP, and survival times were measured from the date of radiosurgery and estimated using the Kaplan-Meier method.


RESULTS
All patients experienced symptomatic response, usually pain resolution. The median local FFP, regional FFP, locoregional FFP, and survival times were 15.4, 12.0, 10.0, and 21.2 months, respectively. The 1-year local FFP probabilities are 93% and 59%, respectively. Local FFP, allowing for salvage radiosurgery, was 100% at 1 year and 75% at 2 years. Five of seven patients with locoregional failure underwent repeat radiosurgery, successfully achieving control for an additional 4.4 to 13.4 months in four patients. One patient had radiation necrosis develop.


CONCLUSIONS
Radiosurgery provided good local control and symptomatic relief in patients with recurrent salivary gland malignancies involving the base of skull. In patients with good performance status, radiosurgery should be considered as salvage treatment.
Lee
Nancy
N
Department of Radiation Oncology, University of California San Francisco, 505 Parnassus Ave., L-08 (Box 0226), San Francisco, California 94143-0226, USA. leen@radonc17.ucsf.edu
Millender
Laura E
LE
Larson
David A
DA
Wara
William M
WM
McDermott
Michael W
MW
Kaplan
Michael J
MJ
Sneed
Penny K
PK
D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012468:Salivary Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D012469:Salivary Glands / Q000473:pathology*; D019292:Skull Base Neoplasms / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome