title: Fractionated stereotactic radiotherapy as reirradiation for locally recurrent head and neck cancer.
abstract: OBJECTIVE
  We report early preliminary experience with CyberKnife radiosurgery (RS) as salvage treatment for locally recurrent head and neck cancer (HNC).
  
  
  METHODS
  Between March 2004 and August 2006, 36 patients (44 sites) were treated with CyberKnife RS as reirradiation for locally recurrent HNC. Treatment sites were as follows: nasopharynx (8), maxillary sinus (8), neck lymph nodes (8), skull base (7), nasal cavity (4), retropharyngeal lymph nodes (3), orbit (2), and others (4). Total doses administered were 18-40 Gy (median, 30 Gy) in 3 to 5 fractions to the 65%-85% isodose line for 3-5 consecutive days. Previous external radiation dose ranged from 39.6 to 134.4 Gy (median, 70.2 Gy). Gross tumor volume ranged from 0.2 to 114.9 cm(3) (median, 22.6 cm(3)). Median follow-up was 17.3 months.
  
  
  RESULTS
  Thirty-five of 44 sites were evaluated for response. Fifteen (42.9%) sites achieved complete response, 13 sites (37.1%) achieved a partial response, 3 (8.6%) sites maintained stable disease, and 4 sites (11.4%) showed tumor progression. Grade III acute complications were noted in 13 patients. Late complications were observed in three patients (1 bone necrosis, 2 soft tissue necrosis) during follow-up.
  
  
  CONCLUSIONS
  These preliminary results suggest that fractionated stereotactic radiosurgery is an effective treatment modality as a salvage treatment with good short-term local control. The early overall response rate is encouraging. However, more experience and a longer follow-up are necessary to determine the role of fractionated stereotactic radiosurgery as a salvage treatment of locally recurrent HNC and to define long-term complications.
authors.affiliation: Department of Radiation Oncology, Kangnam St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Kwang-Won
authors.initials: KW
authors.lastname: Roh
authors.forename: Ji-Sun
authors.initials: JS
authors.lastname: Jang
authors.forename: Min-Sik
authors.initials: MS
authors.lastname: Kim
authors.forename: Dong-Il
authors.initials: DI
authors.lastname: Sun
authors.forename: Bum-Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: So-Lyoung
authors.initials: SL
authors.lastname: Jung
authors.forename: Jin-Hyoung
authors.initials: JH
authors.lastname: Kang
authors.forename: Eun-Jung
authors.initials: EJ
authors.lastname: Yoo
authors.forename: Sei-Chul
authors.initials: SC
authors.lastname: Yoon
authors.forename: Hong-Seok
authors.initials: HS
authors.lastname: Jang
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Chung
authors.forename: Yeon-Sil
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D011832:Radiation Injuries / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011879:Radiotherapy Dosage; D012074:Remission Induction / Q000379:methods; D019233:Retreatment / Q000379:methods; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D047368:Tumor Burden; D055815:Young Adult