International Journal of Head and Neck Surgery

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VOLUME 12 , ISSUE 2 ( April-June, 2021 ) > List of Articles

Original Article

Preliminary Analysis of CyberKnife Stereotactic Radiotherapy for Primary and Recurrent Head and Neck Cancers: A Delicate Balance

Trinanjan Basu, Tejinder Kataria, Shikha Goyal, Deepak Gupta

Keywords : CyberKnife, Radiosurgery, Recurrent head and neck cancer, Survival

Citation Information : Basu T, Kataria T, Goyal S, Gupta D. Preliminary Analysis of CyberKnife Stereotactic Radiotherapy for Primary and Recurrent Head and Neck Cancers: A Delicate Balance. Int J Head Neck Surg 2021; 12 (2):43-47.

DOI: 10.5005/jp-journals-10001-1425

License: CC BY-NC 4.0

Published Online: 01-06-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: This is a preliminary analysis of CyberKnife (CK) stereotactic body radiotherapy (SBRT) among the Indian head and neck cancer (HNC) population. Forty-one patients (27 recurrent and 14 primary) were selected and grouped into group I (re-irradiation = 26) and group II [recurrent RT naïve or CK boost after volumetric modulated arc therapy (VMAT)/intensity-modulated radiotherapy (IMRT) = 15]. Histological types included squamous cell carcinoma (38) and adenoid cystic carcinoma (3). Materials and methods: Univariate and multivariate analyses for disease-free survival (DFS) and overall survival (OS) were performed using disease group, median tumor volume, median tumor size, positron emission tomography (PET)-CT median SUVmax, and post-CK response category. Kaplan–Meier survival and Cox proportional ratios were used using SPSS version 19.0. Results: After a median follow-up of 25 months (range: 0–39 months), all patients combined the 2 years OS and DFS were 92 and 45%, respectively. The median OS and DFS were 25 and 10 months among the cohort. Group I had II years OS and DFS of 85 and 25%, respectively, whereas group II had 2 years OS and DFS 98 and 45%, respectively. Till the last follow-up, 33 patients were alive and 5 were lost to follow-up. Eight patients in group I and only one patient in group II had disease progression. Eleven patients in group I and 12 patients in group II had partial to complete response. The median tumor volume was 29.8 cm3 and was found to be a strong statistically significant factor for DFS in univariate (p = 0.007) analysis. Treatment was well tolerated with only three-grade IV toxicities. Conclusion: CyberKnife SBRT is an attractive option for both recurrent and primary HNC. A delicate balance needs to be maintained between disease control and major adverse events.


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  1. Bernier J, Domenge C, Ozsahin M, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004;350(19):1945–1952. DOI: 10.1056/NEJMoa032641.
  2. Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004;350(19):1937–1944. DOI: 10.1056/NEJMoa032646.
  3. Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006;354(6):567–578. DOI: 10.1056/NEJMoa053422.
  4. Adler JR, Murphy MJ, Chang SD, et al. Image-guided robotic radiosurgery. Neurosurgery 1999;44(6):1299–1306. DOI: 10.1227/00006123-199906000-00079.
  5. Chang SD, Adler JR. Robotics and radiosurgery—the CyberKnife. Stereotact Funct Neurosurg 2001;76(3-4):204–208. DOI: 10.1159/000066719.
  6. Kataria T, Basu T, Goyal S, et.al. Preliminary results of CyberKnife stereotactic radiotherapy (SBRT) boost for primary head and neck cancers: Is it the future direction? J Radiother Pract 2015;14(2):187–193. DOI: 10.1017/S1460396914000521.
  7. Eisenhauer EA, Therasse P, Bogaerts J, et.al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45(2):228–247. DOI: 10.1016/j.ejca.2008.10.026.
  8. Bachar GY, Goh C, Goldstein DP, et al. Long-term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy. Eur Arch Otorhinolaryngol 2010;267(2):295–301. DOI: 10.1007/s00405-009-1070-0.
  9. Argiris A, Ghebremichael M, Gilbert J, et al. Phase III randomized, placebo controlled trial of docetaxel with or without gefitinib in recurrent or metastatic head and neck cancer: an eastern cooperative oncology group trial. J Clin Oncol 2013;31(11):1405–1414. DOI: 10.1200/JCO.2012.45.4272.
  10. Soulieres D, Senzer NN, Vokes EE, et al. Multicenter phase II study of erlotinib, an oral epidermal growth factor receptor tyrosine kinase inhibitor, in patients with recurrent or metastatic squamous cell cancer of the head and neck. J Clin Oncol 2004;22(1):77–85. DOI: 10.1200/JCO.2004.06.075.
  11. Siddiqui F, Patel M, Khan M, et al. Stereotactic body radiation therapy for primary, recurrent, and metastatic tumors in the head-and-neck region. Int J Radiat Oncol Biol Phys 2009;74(4):1047–1053. DOI: 10.1016/j.ijrobp.2008.09.022.
  12. Cacicedo J, Navarro A, Alongi F, et.al. The role of re-irradiation of secondary and recurrent head and neck carcinomas. Is it a potentially curative treatment? A practical approach. Cancer Treat Rev 2014;40(1):178–189. DOI: 10.1016/j.ctrv.2013.08.002.
  13. Fuks Z, Kolesnick R. Engaging the vascular component of the tumor response. Cancer Cell 2005;8(2):89–91. DOI: 10.1016/j.ccr.2005.07.014.
  14. Roh KW, Jang JS, Kim MS, et al. Fractionated stereotactic radiotherapy as reirradiation for locally recurrent head and neck cancer. Int J Radiat Oncol Biol Phys 2009;74(5):1348–1355. DOI: 10.1016/j.ijrobp.2008.10.013.
  15. Mazeron JJ, Ardiet JM, Haie-Méder C, et.al. GEC-ESTRO recommendations for brachytherapy for head and neck squamous cell carcinomas. Radiother Oncol 2009;91(2):150–156. DOI: 10.1016/j.radonc.2009.01.005.
  16. Mantel F, Flentje M, Guckenberger M. Stereotactic body radiation therapy in the re-irradiation situation––a review. Radiat Oncol 2013;8(1):7. DOI: 10.1186/1748-717X-8-7.
  17. Unger KR, Lominska CE, Deeken JF, et al. Fractionated stereotactic radiosurgery for reirradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010;77(5):1411–1419. DOI: 10.1016/j.ijrobp.2009.06.070.
  18. Kodani N, Yamazaki H, Tsubokura T, et al. Stereotactic body radiation therapy for head and neck tumor: disease control and morbidity outcomes. J Radiat Res 2011;52(1):24–31. DOI: 10.1269/jrr.10086.
  19. Uno T, Isobe K, Ueno N, et.al. Fractionated stereotactic radiotherapy as a boost treatment for tumors in the head and neck region. J Radiat Res 2010;51(4):449–454. DOI: 10.1269/jrr.10040.
  20. Le QT, Tate D, Koong A, et.al. Improved local control with stereotactic radiosurgical boost in patients with nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2003;56(4):1046–1054. DOI: 10.1016/S0360-3016(03)00117-2.
  21. Wu SX, Chua DTT, Deng ML, et.al. Outcome of fractionated stereotactic radiotherapy for 90 patients with locally persistent and recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2007;69(3):761–769. DOI: 10.1016/j.ijrobp.2007.03.037.
  22. Rwigema JCM, Heron DE, Ferris RL, et.al. The impact of tumor volume and radiotherapy dose on outcome in previously irradiated recurrent squamous cell carcinoma of the head and neck treated with stereotactic body radiation therapy. Am J Clin Oncol 2011;34(4): 372–379. DOI: 10.1097/COC.0b013e3181e84dc0.
  23. Chopra S, Gupta T, Agarwal JP, et al. Reirradiation in the management of isolated neck recurrences: current status and recommendations. Radiother Oncol 2006;81(1):1–8. DOI: 10.1016/j.radonc.2006. 08.017.
  24. Mcdonald MW, Moore MG, Peter AS. Risk of carotid blow out after reirradiation of the head and neck: a systematic review. Int J Radiat Oncol Biol Phys 2012;82(3):1083–1089. DOI: 10.1016/j.ijrobp.2010.08.029.
  25. Yamazaki H, Ogita M, Kodani N, et.al. Frequency, outcome and prognostic factors of carotid blowout syndrome after hypofractionated re-irradiation of head and neck cancer using CyberKnife: a multi-institutional study. Radiother Oncol 2013;107(3):305–309. DOI: 10.1016/j.radonc.2013.05.005.
  26. Spencer SA, Harris J, Wheeler RH, et al. Final report of RTOG 9610, a multiinstitutional trial of reirradiation and chemotherapy for unresectable recurrent squamous cell carcinoma of the head and neck. Head Neck 2008;30(3):281–288. DOI: 10.1002/hed. 20697.
  27. Hoebers F, Heemsbergen W, Moor S, et al. Reirradiation for head-and-neck cancer: delicate balance between effectiveness and toxicity. Int J Radiat Oncol Biol Phys 2011;81(3):e111–e118. DOI: 10.1016/j.ijrobp.2011.01.004.
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