January 11, 2010 - Reirradiation using fractionated stereotactic radiosurgery (SRS) after previous radiotherapy for head-and-neck cancer is feasible, concluded researchers a study published in the Official Journal of the American Society for Radiation Oncology.
The researchers wanted to find the feasibility of stereotactic radiosurgery (SRS) because it “is an appealing treatment option after previous radiotherapy because of its precision, conformality, and reduced treatment duration.”
From 2002 to 2008, 65 patients received SRS to the oropharynx (13), hypopharynx (8), nasopharynx (7), paranasal sinus (7), neck (7), and other sites (23). Thirty-eight patients were treated definitively and 27 patients with metastatic disease and/or untreated local disease were treated palliatively. Nine patients underwent complete macroscopic resection before SRS. Thirty-three patients received concurrent chemoradiation. The median initial radiation dose was 67 Gy, and the median reirradiation SRS dose was 30 Gy (21–35 Gy) in 2–5 fractions.
Follow-up was on average 16 months for surviving patients. Fifty-six patients were evaluable for response: 30 (54 percent) had complete, 15 (27 percent) had partial, and 11 (20 percent) had no response. The overall survival (OS) for all patients averaged 12 months. For definitively treated patients, the 2-year OS and locoregional control (LRC) rates were 41 percent and 30 percent, respectively. Multivariate analysis demonstrated that higher total dose, surgical resection, and nasopharynx site were significantly associated with improved LRC; surgical resection and nonsquamous histology were associated with improved OS. Seven patients (11 percent) experienced severe reirradiation-related toxicity, including one treatment-attributed death.
Researchers concluded their findings showing SRS reirradiation for head-and-neck cancer a feasible demonstrated encouraging response rates with acceptable toxicity.
But they cautioned, “Fractionated SRS reirradiation with concurrent chemotherapy in select patients warrants further study.”
Reference: Unger, M.D., K.; Lominska, M.D., C.; Deeken, M.D., J.; et al. Fractionated Stereotactic Radiosurgery for Reirradiation of Head-and-Neck Cancer. doi:10.1016/j.ijrobp.2009.06.070
For more information: www.redjournal.org