Frameless Stereotactic Radiosurgery for Recurrent Head and Neck Carcinoma

Abstract

The aim of this study was to assess the feasibility and toxicity of stereotactic radiosurgery (CK-SRS) using the CyberKnife Frameless Radiosurgery System (Accuray Inc., Sunnyvale, CA) in the management of recurrent squamous cell carcinoma of the head and neck region (SCCHN). Between November 2001 and February 2004, 22 patients with recurrent, previously irradiated SCCHN were treated with CK-SRS. The following endpoints were assessed post-CK-SRS: local control (LC), cause-specific survival (CSS), overall survival (OS), symptom relief, and acute and late toxicity. Kaplan-Meier survival analyses were used to estimate the LC, CSS, and OS rates. Clinical symptoms were graded as "improved," "stable," or "progressed" after CK-SRS. Acute and late toxicity were graded according to the National Cancer Institute Common Toxicity Criteria (CTC) scale, version 2.0. Seventeen patients were followed until their death. The median follow-up in the remaining five patients was 19 months (range 11-40 months). The median survival time for the entire cohort was 12 months from the time of CK-SRS. The 2-year LC, CSS, and OS rates were 26%, 26%, and 22%, respectively. After CK-SRS, symptoms were improved or stable in all but one patient who reported increasing pain. The treatment was well tolerated, with one case each of Grade 2 and 3 mucositis. There were no acute Grade 4 or 5 CTC toxicities. There were no late toxicities in this cohort. Frameless stereotactic radiosurgery for recurrent SCCHN is feasible and safe in the setting of high doses of prior irradiation. The majority of patients experienced palliation of disease without excess toxicity.

Stereotactic Body Radiation Therapy for Primary, Recurrent, and Metastatic Tumors in the Head-and-Neck Region

“…Radiosurgery experience in patients with head-and-neck sites mostly has been with nasopharyngeal cancers or baseof-skull tumors (19)(20)(21)(22)(23)(24)(25)(26). Voynov et al (8) reported their experience using stereotactic radiation therapy in 22 patients with recurrent unresectable previously radiated headand-neck cancers in the pharynx, larynx, and neck nodes using the Cyber Knife (Accuray, Sunnyvale, CA) system. Median overall survival in their group of patients was 12 months, with 2-year local control, cause-specific survival, and overall survival rates of 26%, 26%, and 22%, respectively.…”

Stereotactic radiotherapy with CyberKnife for a large angiosarcoma of the maxillary sinus: A case report

“…Recent reports have indicated the usefulness of these new techniques for the management of head and neck tumors [13][14][15][16][17][18]. The CyberKnife system is a robotic stereotactic radiosurgery/radiotherapy device that can deliver a high dose of radiation precisely and with minimal damage to surrounding tissue [19][20][21].…”

Monte Carlo evaluation of tissue heterogeneities corrections in the treatment of head and neck cancer patients using stereotactic radiotherapy

“…Stereotactic radiosurgery has been used for the treatment of skull base tumors over the past few decades and has demonstrated durable tumor control and symptomatic relief with acceptable toxicity in the patients with malignant tumors less than 4 cm in diameter. (18,19) Many researchers have described the utilization of SRT for reirradiation of head and neck tumors, primarily using CyberKnife (Accuray Inc., Sunnyvale, CA) radiosurgery (20)(21)(22)(23)(24) and linac-based SRT. (25,26) Specifically, Unger and colleagues (20) presented a feasibility study reirradiating head and neck cancer patients using CyberKnife technique with fractionated-SRS scheme.…”