International journal of radiation oncology, biology, physics 2009-12-01
Stereotactic body radiotherapy for recurrent squamous cell carcinoma of the head and neck: results of a phase I dose-escalation trial.
Abstract
Purpose
To evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) in previously irradiated patients with squamous cell carcinoma of the head and neck (SCCHN).
Patients and methods
In this Phase I dose-escalation clinical trial, 25 patients were treated in five dose tiers up to 44 Gy, administered in 5 fractions over a 2-week course. Response was assessed according to the Response Evaluation Criteria in Solid Tumors and [(18)F]-fluorodeoxyglucose standardized uptake value change on positron emission tomography-computed tomography (PET-CT).
Results
No Grade 3/4 or dose-limiting toxicities occurred. Four patients had Grade 1/2 acute toxicities. Four objective responses were observed, for a response rate of 17% (95% confidence interval 2%-33%). The maximum duration of response was 4 months. Twelve patients had stable disease. Median time to disease progression was 4 months, and median overall survival was 6 months. Self-reported quality of life was not significantly affected by treatment. Fluorodeoxyglucose PET was a more sensitive early-measure response to treatment than CT volume changes.
Conclusion
Reirradiation up to 44 Gy using SBRT is well tolerated in the acute setting and warrants further evaluation in combination with conventional and targeted therapies.
Related Questions
Do you give Cetuximab concurrently with SBRT for recurrent head and neck cancers previous treated with definitive radiation?
This is an area of active clinical trial development esp. as it relates to immunotherapy concurrent with SBRT. That being said, we certainly have phase I, II, and preliminary phase III data suggesting that SBRT in the setting of recurrent disease is safe and may offer extended LR control rates in a ...
What cumulative dose would you allow the pharyngeal carotid to receive for a course of reirradiation for a retropharyngeal node?
No dosimetric data available. I don't use a carotid OAR in my cases, and just ensure the disease is appropriately covered, while limiting cord/brainstem primarily.From the literature, highest risk cases are those with skin involvement (ie tumor from skin to carotid). Risk of 1-5% for carotid blowout...