title: Reirradiation using robotic image-guided stereotactic radiotherapy of recurrent head and neck cancer.
abstract: The purpose of this study was to examine the prognosis for patients with head and neck cancer after reirradiation using Cyberknife stereotactic body irradiation with special focus on mucosal ulceration. We conducted a retrospective multi-institutional review of 107 patients with previously irradiated head and neck cancer. The median follow-up time for all patients was 15 months, and the 2-year overall survival rate was 35%. Significant prognostic factors for overall survival were primary site (nasopharynx versus other sites), presence of ulceration, and PTV volume. Detailed analysis of ulceration showed a lower response rate (28%) in the ulceration (+) group than the ulceration (-) group (63%; P = 0.0045). The 2-year overall survival rates were 8% in the ulceration (+) group and 42.7% (P = 0.0001) in the ulceration (-) group, respectively. We recorded 22 severe toxicities, including 11 patients with carotid blow-out syndrome (CBOS), which was fatal in 9 patients. CBOS occurred in 6 patients with ulceration (6/25; 24%), and 5 patients experienced CBOS without ulceration (5/82; 6%; P=0.027). In conclusion, ulceration is an important prognostic factor, not only for adverse events but also for survival after reirradiation using CyberKnife.
authors.affiliation: Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan CyberKnife Center, Soseikai General Hospital, 126 Kami-Misu, Shimotoba Fushimi-ku, Kyoto, Japan hideya10@hotmail.com.
authors.forename: Hideya
authors.initials: H
authors.lastname: Yamazaki
authors.affiliation: Radiotherapy Department, Fujimoto Hayasuzu Hospital, Hayasuzu 17-1, Miyakonojo, Miyazaki 885-0055, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Ogita
authors.affiliation: Department of Radiology, Japanese Red Cross Okayama Hospital, Aoe 2-1-1, Kita-ku, Okayama, Okayama, 700-8607, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Himei
authors.affiliation: Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Satoaki
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Suzuki
authors.affiliation: Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Kotsuma
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Yoshioka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011379:Prognosis; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D000069475:Re-Irradiation; D012371:Robotics; D015996:Survival Rate
keywords: head and neck cancer; reirradiation; stereotactic radiotherapy; ulceration