Fractionated stereotactic radiotherapy as reirradiation for locally recurrent head and neck cancer.
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.
Roh
Kwang-Won
KW
Department of Radiation Oncology, Kangnam St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Jang
Ji-Sun
JS
Kim
Min-Sik
MS
Sun
Dong-Il
DI
Kim
Bum-Soo
BS
Jung
So-Lyoung
SL
Kang
Jin-Hyoung
JH
Yoo
Eun-Jung
EJ
Yoon
Sei-Chul
SC
Jang
Hong-Seok
HS
Chung
Su-Mi
SM
Kim
Yeon-Sil
YS
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