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Single Fraction Stereotactic Radiosurgery for Retreatment of Skull Base Recurrent Head and Neck Malignancies

INTRODUCTION: Recurrent head and neck carcinomas are notoriously difficult to treat. Salvage surgery, brachytherapy, and repeat external beam radiotherapy have all been utilized, achieving modest local control at the expense of elevated toxicity. We performed a retrospective review to evaluate the e...

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Autores principales: Patel, Rajal A, Lock, Derrick, Kim, Thomas, Samant, Sandeep, Chandler, James P, Mittal, Bharat B, Kruser, Tim J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451202/
https://www.ncbi.nlm.nih.gov/pubmed/28580203
http://dx.doi.org/10.7759/cureus.1206
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author Patel, Rajal A
Lock, Derrick
Kim, Thomas
Samant, Sandeep
Chandler, James P
Mittal, Bharat B
Kruser, Tim J
author_facet Patel, Rajal A
Lock, Derrick
Kim, Thomas
Samant, Sandeep
Chandler, James P
Mittal, Bharat B
Kruser, Tim J
author_sort Patel, Rajal A
collection PubMed
description INTRODUCTION: Recurrent head and neck carcinomas are notoriously difficult to treat. Salvage surgery, brachytherapy, and repeat external beam radiotherapy have all been utilized, achieving modest local control at the expense of elevated toxicity. We performed a retrospective review to evaluate the efficacy of single fraction stereotactic radiosurgery (SRS) for the treatment of recurrent head and neck carcinomas. METHODS: Eighteen previously irradiated patients diagnosed with a locoregionally recurrent head and neck malignancy and treated with single fraction SRS from 2000 to 2016 were analyzed. Actuarial rates for local control (LC) and overall survival (OS) were calculated with Kaplan-Meier estimates. RESULTS: Median follow-up was 16.1 months and SRS dose was 13.3 Gy. One-year rate of LC was 52.7% (95% confidence interval [CI] 29%-72%). Median OS was 25.4 months. Parotid gland primary had an increased risk of progressive disease (PD) following SRS (hazard ratio [HR] 4.24, p=0.02). Squamous cell histology was negatively associated with OS (HR 3.85, p=0.03). One patient experienced grade 2 radionecrosis. CONCLUSIONS: Single fraction SRS is an acceptable treatment for previously irradiated patients with recurrent head and neck primary malignancies. Dose escalation to optimize LC should be examined.
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spelling pubmed-54512022017-06-02 Single Fraction Stereotactic Radiosurgery for Retreatment of Skull Base Recurrent Head and Neck Malignancies Patel, Rajal A Lock, Derrick Kim, Thomas Samant, Sandeep Chandler, James P Mittal, Bharat B Kruser, Tim J Cureus Oncology INTRODUCTION: Recurrent head and neck carcinomas are notoriously difficult to treat. Salvage surgery, brachytherapy, and repeat external beam radiotherapy have all been utilized, achieving modest local control at the expense of elevated toxicity. We performed a retrospective review to evaluate the efficacy of single fraction stereotactic radiosurgery (SRS) for the treatment of recurrent head and neck carcinomas. METHODS: Eighteen previously irradiated patients diagnosed with a locoregionally recurrent head and neck malignancy and treated with single fraction SRS from 2000 to 2016 were analyzed. Actuarial rates for local control (LC) and overall survival (OS) were calculated with Kaplan-Meier estimates. RESULTS: Median follow-up was 16.1 months and SRS dose was 13.3 Gy. One-year rate of LC was 52.7% (95% confidence interval [CI] 29%-72%). Median OS was 25.4 months. Parotid gland primary had an increased risk of progressive disease (PD) following SRS (hazard ratio [HR] 4.24, p=0.02). Squamous cell histology was negatively associated with OS (HR 3.85, p=0.03). One patient experienced grade 2 radionecrosis. CONCLUSIONS: Single fraction SRS is an acceptable treatment for previously irradiated patients with recurrent head and neck primary malignancies. Dose escalation to optimize LC should be examined. Cureus 2017-05-01 /pmc/articles/PMC5451202/ /pubmed/28580203 http://dx.doi.org/10.7759/cureus.1206 Text en Copyright © 2017, Patel et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Oncology
Patel, Rajal A
Lock, Derrick
Kim, Thomas
Samant, Sandeep
Chandler, James P
Mittal, Bharat B
Kruser, Tim J
Single Fraction Stereotactic Radiosurgery for Retreatment of Skull Base Recurrent Head and Neck Malignancies
title Single Fraction Stereotactic Radiosurgery for Retreatment of Skull Base Recurrent Head and Neck Malignancies
title_full Single Fraction Stereotactic Radiosurgery for Retreatment of Skull Base Recurrent Head and Neck Malignancies
title_fullStr Single Fraction Stereotactic Radiosurgery for Retreatment of Skull Base Recurrent Head and Neck Malignancies
title_full_unstemmed Single Fraction Stereotactic Radiosurgery for Retreatment of Skull Base Recurrent Head and Neck Malignancies
title_short Single Fraction Stereotactic Radiosurgery for Retreatment of Skull Base Recurrent Head and Neck Malignancies
title_sort single fraction stereotactic radiosurgery for retreatment of skull base recurrent head and neck malignancies
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451202/
https://www.ncbi.nlm.nih.gov/pubmed/28580203
http://dx.doi.org/10.7759/cureus.1206
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