title: Fractionated stereotactic radiosurgery for reirradiation of head-and-neck cancer.
abstract: OBJECTIVE
  Stereotactic radiosurgery (SRS) is an appealing treatment option after previous radiotherapy because of its precision, conformality, and reduced treatment duration. We report our experience with reirradiation using fractionated SRS for head-and-neck cancer.
  
  
  METHODS
  From 2002 to 2008, 65 patients received SRS to the oropharynx (n = 13), hypopharynx (n = 8), nasopharynx (n = 7), paranasal sinus (n = 7), neck (n = 7), and other sites (n = 23). Thirty-eight patients were treated definitively and 27 patients with metastatic disease and/or untreated local disease were treated palliatively. Nine patients underwent complete macroscopic resection before SRS. Thirty-three patients received concurrent chemoradiation. The median initial radiation dose was 67 Gy, and the median reirradiation SRS dose was 30 Gy (21-35 Gy) in 2-5 fractions.
  
  
  RESULTS
  Median follow-up for surviving patients was 16 months. Fifty-six patients were evaluable for response: 30 (54%) had complete, 15 (27%) had partial, and 11 (20%) had no response. Median overall survival (OS) for all patients was 12 months. For definitively treated patients, the 2-year OS and locoregional control (LRC) rates were 41% and 30%, respectively. Multivariate analysis demonstrated that higher total dose, surgical resection, and nasopharynx site were significantly associated with improved LRC; surgical resection and nonsquamous histology were associated with improved OS. Seven patients (11%) experienced severe reirradiation-related toxicity, including one treatment-attributed death.
  
  
  CONCLUSIONS
  SRS reirradiation for head-and-neck cancer is feasible. This study demonstrates encouraging response rates with acceptable toxicity. Fractionated SRS reirradiation with concurrent chemotherapy in select patients warrants further study.
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, Washington, DC 20007, USA. kxu2@gunet.georgetown.edu
authors.forename: Keith R
authors.initials: KR
authors.lastname: Unger
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Lominska
authors.forename: John F
authors.initials: JF
authors.lastname: Deeken
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Davidson
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Newkirk
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gagnon
authors.forename: Jimmy
authors.initials: J
authors.lastname: Hwang
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Slack
authors.forename: Anne-Michelle
authors.initials: AM
authors.lastname: Noone
authors.forename: K William
authors.initials: KW
authors.lastname: Harter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000601:surgery; D010166:Palliative Care / Q000379:methods; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D019233:Retreatment / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents