Stereotactic body radiation therapy for locally recurrent, previously irradiated nonsquamous cell cancers of the head and neck

Abstract

SBRT for previously irradiated, locally recurrent NSCHN provides promising local control, especially for tumors <25 mL, with minimal toxicity. The optimal dose for larger tumors remains to be defined.

Re-irradiation of adenoid cystic carcinoma: Analysis and evaluation of outcome in 52 consecutive patients treated with raster-scanned carbon ion therapy

“…Despite high re-irradiation doses, the most common site of relapse is still within the re-treatment field, which is consistent with observations by other groups [25,29,31,32,34,[36][37][38][39]48] and further supports our target volume definition concept. In contrast to Duprez, Lee, Haraf, Salama, Hoebers, De Crevoisier we have found no significant correlation of either local control or overall survival with re-irradiation dose, time interval or target volume [11,[13][14][15]25,31].…”

“…Tumour response went as high as 53.8% (CR/PR), which compares favourably with reported results including patients with other histologies (Adenoid cystic carcinoma: 27% of patients) [39]. Saroja et al reported complete responses of 83% in patients with adenocarcinoma, while reported local control at 2 years is only 44% in this series [9] compared to 47.4% (median local control: 19 months) in our heavily pre-treated patient cohort.…”

Stereotactic body radiotherapy for recurrent oropharyngeal cancer – Influence of HPV status and smoking history

“…SBRT techniques for target delineation, patient setup, and treatment/delivery have been previously described 7,8,10,11 Briefly, SBRT planning was CT-based or PET/CT-based with custom thermoplastic mask for immobilization delivered using one of several treatment platforms including Cyberknife™ (Accuracy, Inc., Sunnyvale, CA), Trilogy™, and TrueBeam™ (Varian Medical Systems Inc., Palo Alto, CA). SBRT consisted of 40-50Gy in 5 fractions depending on treatment volume ≥25cc, delivered on alternating days over 1-2 weeks.…”

“…Initially in our dose-escalation experience, planning target volume (PTV) equaled gross tumor volume (GTV) with no expansion margin, however based on recent patterns of failure outcomes analysis, we now incorporate a maximum 5mm GTV to PTV expansion depending on treatment volume, prior treatment, and proximity to surrounding critical structures. 10-12 Organs-at-risk included the spinal cord in all cases and brainstem as well as the parotids, pharyngeal constrictor muscles, mandible and oral cavity depending on treatment site. Dose limit to the spinal cord was set at 8Gy with SBRT.…”

Stereotactic Body Radiotherapy (SBRT) for primary and recurrent head and neck tumors

“…Our published results showed promising local control in these patients with minimal toxicity, especially if the tumor volume is less than 25 ml. 23 Despite these encouraging results, toxicities following re-irradiation to the head and neck may be severe or even life threatening in some patients. An early large series involving 169 patients who received full dose re-irradiation to the head and neck sites resulted in a relatively unacceptable high complication rates, including mucosal necrosis in 21%, osteoradionecrosis in 8% and 5 deaths from carotid hemorrhage.…”