Stereotactic Body Radiation Therapy for Head and Neck Tumor: Disease Control and Morbidity Outcomes

Abstract

We evaluated the efficacy and safety of stereotactic body radiation therapy (SBRT) for patients with head and neck tumors. From April 2005 through April 2008, 34 patients with head and neck tumors were treated with CyberKnife SBRT. Twenty-one of them had prior radiotherapy. Treatment sites were orbit (n = 7), cervical lymph nodes (n = 6), nasopharynx (n = 5), oropharynx (n = 4) and others (n = 12). The prescribed dose ranged from 19.5 to 42 Gy (median, 30 Gy) in 3-8 fractions for consecutive days. The target volume ranged from 0.7 to 78.1 cm(3) (median, 11.6 cm(3)). The median follow-up was 16 months. Treatment was well tolerated without significant acute complications in any cases. Complete response rate and partial response rate were 32.4% and 38.6%, respectively. The overall survival rates were 70.6% and 58.3% at 12 and 24 months, respectively. The overall survival was better in patients without prior radiotherapy within the previous 24 months or in case of smaller target volume. Six patients suffered severe late complications. All these patients had prior radiotherapy, and 2 of them developed massive hemorrhage in the pharynx and both died of this complication 5 and 28 months, respectively, after SBRT. Our preliminary results suggest that SBRT is an effective treatment modality for head and neck tumors. However, re-irradiation has significant risk of severe and even fatal late complications in the form of necrosis and hemorrhage in re-irradiated areas.

Is Stereotactic Body Radiotherapy (SBRT) in lymph node oligometastatic patients feasible and effective?

“…11,12 Thirty one clinical series reporting treatment outcome (in the series of 1-69 cases of lymph node recurrence) were divided in those including patients treated with SBRT only for lymph node recurrent cancer (12 articles) [32][33][34][35][36][37][38][39][40][41][42][43] and those on the patients treated for any oligometastatic cancer to any sites including lymph nodes (19 articles). [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The first article of this series was published in 2005. 23 Twenty eight out of 31 articles (90%) have been published in the last 6 years (2008-2013).…”

“…Nineteen out of 31 clinical series reporting outcome included patients treated with SBRT for any site including lymph node recurrence [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] (Table 2). Nine studies (29%) were prospective, including 1 phase I trial.…”

Stereotactic radiotherapy in locally recurrent nasopharyngeal cancer

“…[14] 34 baş-boyun kanserli (21 hasta daha önce radyoterapi almış) hastayı CK ile tedavi etmişler-dir. Tedavi bölgeleri 7 orbita, 6 servikal lenf nodu, 5 nazofarenks, 4 orofarenks ve 12 diğerleri olarak alınmış-tır.…”

“…Daha önce radyoterapi almamış hastalarda sağkalım daha iyi bulunmuştur. [14] Cengiz ve ark. [3] nükseden, daha önce radyoterapi almış, rezeksiyon uygulanamayacak durumdaki 46 (22 kadın, 24 erkek) baş-boyun kanserli hastayı CK kullanarak tedavi etmişlerdir.…”

Stereotactic body radiation therapy in head and neck, gynecologic, and pediatric malignancies

“…Even in newly diagnosed head and neck cancers, there are situations where standard EBRT may not be possible due to medical reasons. In very exceptional and selected cases, SBRT has been used as upfront treatment in these patients [11,12]. An example of such a situation is where an early stage lesion is well delineated and confined to the site of origin with no lymph node involvement.…”