Salvage Stereotactic Body Radiotherapy For Locally Recurrent Head And Neck Carcinomas

Purpose/Objective(s)The purpose of this study is to determine the efficacy and toxicity of stereotactic body radiotherapy (SBRT) as a salvage treatment in patients with locally persistent and recurrent head and neck carcinomas (HNC).Materials/MethodsBetween July 2007 and November 2008, 35 patients with locally recurrent HNC were treated by SBRT. The sites of disease distribution were as follows: nasopharyngeal cancer, 16; paranasal sinus cancer, 7; oral cavity cancer, 3; hypopharyngeal cancer, 4; laryngeal cancer, 1; thyroid cancer, 1; tracheal cancer,1; lacrimal gland cancer, 1; and parotid cancer; 1. All patients had previously received full dose radical external beam radiotherapy. Median first line radiotherapy dose was 65,5 Gy (range, 30 Gy-77,4 Gy. Time from the previous radiotherapy to SBRT was median 66 months (range, 7-300 months). Ten patients were treated for two or more recurrences and five of these had taken second re-irradiation before SBRT. Median SBRT dose was 30 Gy (18-35 Gy) in median 5 fractions (1-5 fractions) in median 5 days (1-8 days) to typically 75-85% prescription isodoses. Median follow up time was 8 months (range, 4-18 months).ResultsSeven patients had complete regression of tumor after SBRT, eleven had partial response, ten had stable disease, and six had progression of tumor. The overall response rate was 51.4% (n = 18). SBRT established ultimate disease control in 80 % (n = 28) of the patients. Disease progression in six patients occurred in median 6 months (range, 2-9 months) after SBRT. One year survival is 66.7%. Thirteen patients (%37) were complained of grade II-III toxicities; mucositis, dysphagia, feeding tube, fistula, myelitis and soft tissue necrosis. Moreover, three of four patients who have presented with profuse bleeding as life threatening toxicity after 2-3 months of SBRT were died.ConclusionsOur early result is encouraging that SBRT is an effective treatment modality with relatively good disease control for recurrent head and neck cancer. Major treatment related mortality is bleeding. Longer follow up with increased number of patients is essential to determine the definitive role of SBRT in this group of patients. Purpose/Objective(s)The purpose of this study is to determine the efficacy and toxicity of stereotactic body radiotherapy (SBRT) as a salvage treatment in patients with locally persistent and recurrent head and neck carcinomas (HNC). The purpose of this study is to determine the efficacy and toxicity of stereotactic body radiotherapy (SBRT) as a salvage treatment in patients with locally persistent and recurrent head and neck carcinomas (HNC). Materials/MethodsBetween July 2007 and November 2008, 35 patients with locally recurrent HNC were treated by SBRT. The sites of disease distribution were as follows: nasopharyngeal cancer, 16; paranasal sinus cancer, 7; oral cavity cancer, 3; hypopharyngeal cancer, 4; laryngeal cancer, 1; thyroid cancer, 1; tracheal cancer,1; lacrimal gland cancer, 1; and parotid cancer; 1. All patients had previously received full dose radical external beam radiotherapy. Median first line radiotherapy dose was 65,5 Gy (range, 30 Gy-77,4 Gy. Time from the previous radiotherapy to SBRT was median 66 months (range, 7-300 months). Ten patients were treated for two or more recurrences and five of these had taken second re-irradiation before SBRT. Median SBRT dose was 30 Gy (18-35 Gy) in median 5 fractions (1-5 fractions) in median 5 days (1-8 days) to typically 75-85% prescription isodoses. Median follow up time was 8 months (range, 4-18 months). Between July 2007 and November 2008, 35 patients with locally recurrent HNC were treated by SBRT. The sites of disease distribution were as follows: nasopharyngeal cancer, 16; paranasal sinus cancer, 7; oral cavity cancer, 3; hypopharyngeal cancer, 4; laryngeal cancer, 1; thyroid cancer, 1; tracheal cancer,1; lacrimal gland cancer, 1; and parotid cancer; 1. All patients had previously received full dose radical external beam radiotherapy. Median first line radiotherapy dose was 65,5 Gy (range, 30 Gy-77,4 Gy. Time from the previous radiotherapy to SBRT was median 66 months (range, 7-300 months). Ten patients were treated for two or more recurrences and five of these had taken second re-irradiation before SBRT. Median SBRT dose was 30 Gy (18-35 Gy) in median 5 fractions (1-5 fractions) in median 5 days (1-8 days) to typically 75-85% prescription isodoses. Median follow up time was 8 months (range, 4-18 months). ResultsSeven patients had complete regression of tumor after SBRT, eleven had partial response, ten had stable disease, and six had progression of tumor. The overall response rate was 51.4% (n = 18). SBRT established ultimate disease control in 80 % (n = 28) of the patients. Disease progression in six patients occurred in median 6 months (range, 2-9 months) after SBRT. One year survival is 66.7%. Thirteen patients (%37) were complained of grade II-III toxicities; mucositis, dysphagia, feeding tube, fistula, myelitis and soft tissue necrosis. Moreover, three of four patients who have presented with profuse bleeding as life threatening toxicity after 2-3 months of SBRT were died. Seven patients had complete regression of tumor after SBRT, eleven had partial response, ten had stable disease, and six had progression of tumor. The overall response rate was 51.4% (n = 18). SBRT established ultimate disease control in 80 % (n = 28) of the patients. Disease progression in six patients occurred in median 6 months (range, 2-9 months) after SBRT. One year survival is 66.7%. Thirteen patients (%37) were complained of grade II-III toxicities; mucositis, dysphagia, feeding tube, fistula, myelitis and soft tissue necrosis. Moreover, three of four patients who have presented with profuse bleeding as life threatening toxicity after 2-3 months of SBRT were died. ConclusionsOur early result is encouraging that SBRT is an effective treatment modality with relatively good disease control for recurrent head and neck cancer. Major treatment related mortality is bleeding. Longer follow up with increased number of patients is essential to determine the definitive role of SBRT in this group of patients. Our early result is encouraging that SBRT is an effective treatment modality with relatively good disease control for recurrent head and neck cancer. Major treatment related mortality is bleeding. Longer follow up with increased number of patients is essential to determine the definitive role of SBRT in this group of patients.