Safety and efficacy of hypofractionated stereotactic body reirradiation in head and neck cancer: Long-term follow-up of a large series.
BACKGROUND
The purpose of this study was to report long-term outcomes for a large cohort of patients with head and neck squamous cell carcinoma (HNSCC) who underwent stereotactic body radiotherapy (SBRT) reirradiation.


METHODS
From 2002 to 2011, 85 patients with previously irradiated HNSCC were treated with SBRT to 94 lesions. Some underwent surgery (29%), and many were treated with induction, concurrent, and/or adjuvant chemotherapy or biologic therapy (70%).


RESULTS
Reirradiation occurred at a median interval from initial radiotherapy (RT) of 32 months. Median follow-up for survivors was 17.3 months. Two-year Kaplan-Meier estimates of overall survival (OS) and locoregional control for patients and lesions treated with curative intent were 24% and 28%, respectively. Interval from initial RT to SBRT of 2 years or more was associated with improved OS (p = .019). Five patients had grade 3 or higher late toxicity (5.9%).


CONCLUSIONS
SBRT reirradiation results in limited toxicity. Further research is needed to refine optimal roles for SBRT and intensity-modulated radiotherapy (IMRT) reirradiation.
Departments of Radiation Oncology, Medical Oncology, and Head and Neck Surgery, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
Marie-Adele S
MA
Kress
Departments of Radiation Oncology, Medical Oncology, and Head and Neck Surgery, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
Neilayan
N
Sen
Departments of Radiation Oncology, Medical Oncology, and Head and Neck Surgery, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
Keith R
KR
Unger
Department of Radiation Oncology, The University of Kansas Hospital, Kansas City, Kansas.
Christopher E
CE
Lominska
Departments of Radiation Oncology, Medical Oncology, and Head and Neck Surgery, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
John F
JF
Deeken
Departments of Radiation Oncology, Medical Oncology, and Head and Neck Surgery, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
Bruce J
BJ
Davidson
Departments of Radiation Oncology, Medical Oncology, and Head and Neck Surgery, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
Kenneth A
KA
Newkirk
Departments of Radiation Oncology, Medical Oncology, and Head and Neck Surgery, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
Jimmy
J
Hwang
Departments of Radiation Oncology, Medical Oncology, and Head and Neck Surgery, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
K William
KW
Harter
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D000069475:Re-Irradiation; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D016896:Treatment Outcome
CyberKnife; head and neck cancer; radiation oncology; reirradiation; stereotactic body radiation therapy