Stereotactic Body Radiotherapy Treatment for Recurrent, Previously Irradiated Head and Neck Cancer

• Authors: Luke Stanisce, Cooper Medical School of Rowan University; Yekaterina Koshkareva, University of Texas MD Anderson Cancer Center; Qianyi Xu, Cooper University Hospital; Ashish Patel, Emory University; Christian Squillante, Cooper University Hospital; Nadir Ahmad, University of Texas MD Anderson Cancer Center; Kumar Rajagopalan, Cooper University Hospital; Gregory J. Kubicek, Cooper University Hospital
• Journal Title: Technology in Cancer Research and Treatment
• Volume: Volume 17
• Publisher: SAGE Publications (UK and US): Open Access Titles | 2018-01-01, Pages 1533033818780086-1533033818780086
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1177/1533033818780086
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery
• Keywords: CyberKnife; head and neck cancer; recurrence; stereotactic body radiation therapy; Adult; Aged; Aged, 80 and over; Female; Head and Neck Neoplasms; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Recurrence, Local; Radiosurgery; Retrospective Studies; Salvage Therapy; Treatment Outcome

Abstract

PURPOSE: Locally recurrent, previously irradiated primary head and neck tumors have historically been associated with poor outcomes. Stereotactic body radiation therapy has emerged as a feasible and promising treatment option for tumor recurrence, particularly in nonsurgical candidates. This study aimed to assess the associated outcomes of stereotactic body radiation therapy used in this setting. METHODS: Retrospective analysis of a prospectively collected database of 25 patients treated with CyberKnife for unresectable, recurrent head and neck cancer in a previously irradiated field. The primary end points evaluated were rates of survival, tumor control, and treatment-related toxicities. RESULTS: Median survival of the study population was 7.5 months (range, 1.5-47.0 months). Median survival of the 20 (80%) patients who were treated with curative purpose was 8.3 months. One-year overall survival rate for the entire population was 32%. The respective 1-year and 2-year survival rates for the curative subcohort were 40% and 20%, respectively. Local and locoregional failure occurred in 8 (32%) and 7 (28%) patients, respectively. Low severe acute (4%) and late (6%) treatment-related toxicity rates were observed. No grade 4 or 5 toxicities were observed. CONCLUSION: Stereotactic body radiation therapy is a viable treatment option for patients with unresectable, recurrent head and neck cancer. Significant tumor control rates are achievable with minimal severe toxicity. Although perhaps associated with patient selection and a heterogeneous sample, overall survival of stereotactic body radiation therapy outcomes appears unfavorable.