Carotid blowout syndrome in pharyngeal cancer patients treated by hypofractionated stereotactic re-irradiation using CyberKnife: A multi-institutional matched-cohort analysis

Yamazaki, Hideya; Ogita, Mikio; Himei, Kengo; Nakamura, Satoaki; Kotsuma, Tadayuki; Yoshida, Ken; Yoshioka, Yasuo

doi:10.1016/j.radonc.2015.02.021

Cited by 68 publications

(57 citation statements)

References 18 publications

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“…Previous studies have suggested radical neck dissection and radiation as major etiological factors in the development of CBS, because they can cause distinct long-term alteration of vessels. 12,16,20,21 CRT can cause the obliteration of the carotid's vasa vasorum, which leads to fibrosis of the adventitia and subsequent weakening of the arterial wall. 5,22 In today's treatment regimes, radical neck dissection might be neglected when considering CBS risks, because this treatment has been mostly replaced by selective neck approaches.…”

Section: Discussionmentioning

confidence: 99%

Chemoradiation and local recurrence of head and neck squamous cell carcinoma and the risk of carotid artery blowout

et al. 2019

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Background Carotid blowout syndrome (CBS) is a rare but life‐threatening complication of head and neck squamous cell carcinoma (HNSCC). Chemoradiation (CRT) may make CBS more likely, but so far no longitudinal analysis of different treatment strategies has been conducted. Methods In the present study, 1072 patients with HNSCC were divided into groups depending on whether they had experienced CBS. Disease‐related data were analyzed using chi‐square test, Fisher exact test, and Student's t test. Survival rates were calculated using Kaplan‐Meier test, log‐rank test, and the Cox regression analysis for forward selection. Results Thirty‐six patients suffering from CBS demonstrated significantly advanced T status (P = .001) and UICC stage (P = .004) when compared with unaltered counterparts. After adjustment for UICC stage, OS was comparable in both groups, whereas the mean recurrence‐free survival (RFS) rate was better in unaltered patients (67 vs 24 months; P < .0001). Cox regression for forward selection revealed local recurrence (hazard ratio [HR], 1.9; P < .0001), T status (HR, 1.9; P = .03), and CRT (HR, 2.0; P < .0001) as independent risk factors for mortality related to CBS. Conclusion CBS is a rare event in patients with HNSCC demonstrating reduced OS/RFS. Advanced T status, C/RT, and the recurrence of local tumors increase the risk of CBS‐associated death.

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Section: Discussionmentioning

confidence: 99%

Chemoradiation and local recurrence of head and neck squamous cell carcinoma and the risk of carotid artery blowout

et al. 2019

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“…Additional risk factors are surrounding of half the carotid artery by the tumor, close local relation of tumor and carotid artery, daily fractionation of the RT, advanced age, infection, and median carotid artery radiation dose beyond 34 Gy. Mucosal ulceration and skin invasion by the tumor by the time of treatment were independent prognosticators for CBOS . All of these factors with the exception of advanced age were not relevant for our 2 patients.…”

Section: Discussionmentioning

confidence: 77%

“…Mucosal ulceration and skin invasion by the tumor by the time of treatment were independent prognosticators for CBOS. 18,[23][24][25][26] All of these factors with the exception of advanced age were not relevant for our 2 patients. Altogether, carotid ruptures in up to 17.8% of the patients were reported.…”

Section: Casementioning

confidence: 91%

Second infield re‐irradiation with a resulting cumulative equivalent dose (EQD2_max) of >180 Gy for patients with recurrent head and neck cancer

et al. 2018

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Background For locally recurrent head and neck cancer, re‐irradiation with modern techniques like stereotactic body radiotherapy is a promising, possibly curative alternative to palliative systemic therapy. Methods We report on 1 patient with nasopharyngeal carcinoma (NPC) and 1 patient with cutaneous squamous cell carcinoma (SCC). Both patients received full dose primary treatment (>66 Gy, EQD2), full dose re‐irradiation (>50 Gy, EQD2), and a second course of re‐irradiation via robotic radiosurgery (CyberKnife) for a second local recurrence. Results Both treatments resulted in adequate tumor response. No grade III‐IV acute or late toxicities occurred. Follow‐up at 6 months after third irradiation showed partial remission for the patient with NPC. In the second case (SCC), no toxicities occurred and the tumor was in remission 18 months after last treatment. Conclusion These cases show that a second course of re‐irradiation utilizing modern techniques like robotic radiosurgery might be feasible for carefully selected patients with head and neck cancer.

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“…The prescribed dose in our case was 21 Gy. Yamazaki et al reported the prescribed dose to head and neck tumor lesions, including cervical lymph node metastases, ranged from 13 Gy to 39 Gy, with a median of 30 Gy [10]. Therefore, a total dose of 21 Gy was thought to be appropriate.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Stereotactic Radiotherapy Using CyberKnife for Recurrent Lymph Node Metastasis of Differentiated Thyroid Cancer

Kawabe

Higashiyama

Sougawa

et al. 2017

Case Reports in Endocrinology

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A woman in her 60s presented with a recurrent lymph node metastasis from a papillary thyroid carcinoma in the right parapharyngeal space. She had already undergone total thyroidectomy, five resections for cervical lymph node metastases, and right carotid rebuilding. Surgical resection of the current metastasis was impossible. 131I-radioiodine therapy (RIT) with 3.7 GBq 131I was not effective; therefore, stereotactic radiation therapy (SRT) using a CyberKnife radiotherapy system was scheduled. The prescription dose was 21 Gy, and a dose covering 95% of the planning target volume (PTV) in three fractions was administered. The PTV was 4,790 mm3. Follow-up magnetic resonance imaging conducted 3 and 12 months after the SRT demonstrated a remarkable and gradual reduction of the recurrent lymph node metastasis in the right parapharyngeal space and no evidence of recurrence. For multidisciplinary therapy of unresectable and/or RIT unresponsive locoregional lymph node metastases and recurrences of DTC, SRT using the CyberKnife system should be considered.

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Carotid blowout syndrome in pharyngeal cancer patients treated by hypofractionated stereotactic re-irradiation using CyberKnife: A multi-institutional matched-cohort analysis

Cited by 68 publications

References 18 publications

Chemoradiation and local recurrence of head and neck squamous cell carcinoma and the risk of carotid artery blowout

Chemoradiation and local recurrence of head and neck squamous cell carcinoma and the risk of carotid artery blowout

Second infield re‐irradiation with a resulting cumulative equivalent dose (EQD2_max) of >180 Gy for patients with recurrent head and neck cancer

Usefulness of Stereotactic Radiotherapy Using CyberKnife for Recurrent Lymph Node Metastasis of Differentiated Thyroid Cancer

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Carotid blowout syndrome in pharyngeal cancer patients treated by hypofractionated stereotactic re-irradiation using CyberKnife: A multi-institutional matched-cohort analysis

Cited by 68 publications

References 18 publications

Chemoradiation and local recurrence of head and neck squamous cell carcinoma and the risk of carotid artery blowout

Chemoradiation and local recurrence of head and neck squamous cell carcinoma and the risk of carotid artery blowout

Second infield re‐irradiation with a resulting cumulative equivalent dose (EQD2max) of >180 Gy for patients with recurrent head and neck cancer

Usefulness of Stereotactic Radiotherapy Using CyberKnife for Recurrent Lymph Node Metastasis of Differentiated Thyroid Cancer

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Second infield re‐irradiation with a resulting cumulative equivalent dose (EQD2_max) of >180 Gy for patients with recurrent head and neck cancer