title: A simple strategy to decrease fatal carotid blowout syndrome after stereotactic body reirradiaton for recurrent head and neck cancers.
abstract: BACKGROUND
  This study aimed to compare the therapeutic outcomes and fatal carotid blow out syndrome (CBOS) incidence rates between two different stereotactic body radiotherapy (SBRT) protocols.
  
  
  METHODS
  The study included 75 patients with inoperable locally recurrent head and neck cancer treated with SBRT in our department between June 2007 and March 2011. The first 43 patients were treated sequentially (group I). Then our SBRT protocol was changed due to the high rate of CBOS, and the following 32 patients were treated every other day in a prospective institutional protocol (group II).
  
  
  RESULTS
  Median overall survival in group I and group II was 11 months and 23 months, respectively (P = 0.006). We observed 11 cases of CBOS. Only 1 of 7 patients (14%) with CBOS survived in group I, whereas 2 of 4 patients (50%) in group II remain alive. CBOS free median overall survivals were 9 months, and 23 months in group I and group II respectively (P = 0.002). The median radiation dose received by the carotid artery in patients with CBOS was 36.5 Gy (range: 34-42.8 Gy), versus 34.7 Gy (range: 0-44 Gy) in the patients that didn't have CBOS (P = 0.15). CBOS did not occur in any of the patients with a maximum carotid artery radiation dose <34 Gy.
  
  
  CONCLUSIONS
  Every other day SBRT protocol for re-irradiation of recurrent head and neck cancer is promising in terms of decreasing the incidence of fatal CBOS.
authors.forename: Gozde
authors.initials: G
authors.lastname: Yazici
authors.forename: Tolga Yusuf
authors.initials: TY
authors.lastname: Sanlı
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cengiz
authors.forename: Deniz
authors.initials: D
authors.lastname: Yuce
authors.forename: Melis
authors.initials: M
authors.lastname: Gultekin
authors.forename: Pervin
authors.initials: P
authors.lastname: Hurmuz
authors.forename: Ferah
authors.initials: F
authors.lastname: Yıldız
authors.forename: Faruk
authors.initials: F
authors.lastname: Zorlu
authors.forename: Fadil
authors.initials: F
authors.lastname: Akyol
authors.forename: Murat
authors.initials: M
authors.lastname: Gurkaynak
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Sihhiye, Ankara, Turkey. gozyigit@hacettepe.edu.tr.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ozyigit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects*; D013577:Syndrome; D055815:Young Adult