Radiosurgery an option for head/neck cancer reirradiation

Aug 18, 2010

The use of fractionated stereotactic radiosurgery (SRS) can provide good response rates and low toxicity for patients with recurrent head and neck cancer, according to a report published in the International Journal of Radiation Oncology, Biology, Physics.

When head and neck cancers recur after radiation therapy, salvage surgical resection is recommended because it offers the greatest probability for long-term survival. Reirradiation is another option, but it is associated with a risk of significant toxicity. For patients who are not good candidates for surgery or whose tumors cannot be completely resected, SRS is a feasible treatment option with good response rates and reduced toxicity, according to the study authors.

Patients at Georgetown University Hospital in Washington, DC, who experience recurrent, second primary, or persistent cancers of the head and neck after having previous radiation therapy are being offered fractionated stereotactic radiosurgery (CyberKnife, Accuray, Sunnyvale, CA) on a case-by-case basis.

The treatment consists of reirradiation with 30-35 Gy in five fractions, with concomitant chemotherapy that begins the week before SRS treatment for a total of three weeks. Most patients tolerate this treatment regimen well, have less risk of developing acute toxicities, and appreciate the shorter treatment duration as compared to other options, according to Keith Unger, MD, of the department of radiation medicine (Int J Radiat Oncol Biol Phys, August 1, 2010, Vol. 77:5, pp.1411-1419).

To evaluate response rates of patients who underwent SRS with and without concurrent chemotherapy, Unger and colleagues reviewed the medical records of 65 consecutive patients who received treatment between May 2002 and December 2007 and who were followed for a median of 16 months. Twenty-seven (41.5%) patients had metastatic disease or untreated local disease and were treated for palliation of symptoms. Nine patients underwent complete macroscopic resection before SRS, and more than half received concurrent chemoradiation.

The authors reported an 81% response rate with a complete response in 54% of treated regions, with improved response rates associated with higher doses. Patients who received definitive treatment had a median overall survival of 20 months, locoregional control of 16 months, and progression-free survival of 5.7 months. This group's two-year overall survival and locoregional control rates were 41% and 30%, respectively.

Almost 30% of the patients experienced Radiation Therapy Oncology Group (RTOG) grade 1 to 3 acute toxicity (mucositis, dermatitis, and nausea), which resolved with conservative management. Six patients experienced severe late radiation-induced RTOG grade 4 toxicity, including arterial bleeding, soft-tissue necrosis, fistula formation, and dysphagia. One patient died of unknown causes attributed to the reirradiation, but 71% tolerated the treatment well.

By Cynthia E. Keen
AuntMinnie.com staff writer
August 19, 2010

New treatment regimen boosts survival in recurrent head and neck cancer, October 21, 2005