Reirradiation of recurrent salivary gland malignancies with fractionated stereotactic body radiation therapy

Abstract

PurposeThe purpose of this study was to review a single-institution experience with the reirradiation of recurrent salivary gland tumors using fractionated stereotactic radiosurgery (SBRT).MethodsBetween 2003 and 2011, 18 patients diagnosed with recurrent, previously irradiated, salivary gland carcinomas were treated with SBRT reirradiation. Median age was 68 for all patients with most tumors being of major salivary gland origin. Most patients did not undergo surgical resection, and among those that did, all had positive margins. Only seven patients received chemotherapy, and the median SBRT dose was 30 Gy given in five fractions with a median cumulative dose of 91.1 Gy.ResultsThe median overall survival (OS), progression-free survival (PFS), and local control (LRC) were 11.5, 3.5, and 5.5 months, respectively. The 2-year OS, PFS, and LRC rates were 39%, 24%, and 53%, respectively. Statistical analysis identified presence of gross disease and interval to reirradiation as negative predictors of survival outcomes on both univariate and multivariate analyses (p < 0.05). On multivariate analysis, tumor volume was a negative predictor of survival outcomes (p < 0.05). Long-term toxicity analysis revealed four patients in the reirradiated group with soft tissue necrosis, which correlated with the cumulative dose (p = 0.01).ConclusionOur data suggest that SBRT is a reasonable treatment option for reirradiation of salivary gland tumors, but further studies are warranted.

Effect of multimodality treatment on overall survival for patients with metastatic or recurrent HPV-positive head and neck squamous cell carcinoma

“…Unfortunately, past clinical studies using standard fractionation reirradiation have shown high rates of severe toxicities, including treatment‐related deaths . Our experience using stereotactic hypofractionated reirradiation has been previously reported, and includes a favorable outcome in terms of low toxicity and the successful treatment of identified lesions . Further, for patients for whom potential cure is the treatment goal with reirradiation, we have found a significant 2‐year overall survival rate of 41% in patients treated for their recurrent neck disease …”

“…[29][30][31] Our experience using stereotactic hypofractionated reirradiation has been previously reported, and includes a favorable outcome in terms of low toxicity and the successful treatment of identified lesions. 32,33 Further, for patients for whom potential cure is the treatment goal with reirradiation, we have found a significant 2-year overall survival rate of 41% in patients treated for their recurrent neck disease. 32 Although the use of metastasectomies has not been thought to be of clinical benefit in HNSCC, our experience highlights the potential benefit of this approach in patients with HPV-positive disease.…”

IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies: A Case Series

“…The small sample size and the retrospective nature of the study prohibit us from performing any correlational analysis for prognosticators of late toxicity. In our previously published reirradiation series, we reported a correlation between cumulative doses over 90 Gy and the development of soft tissue necrosis ( 10 ). In the RTOG-MRC randomized trial that showed 67% LRC compared to 13% in patients with unresectable disease, significant toxicities such as temporal lobe necrosis, ulceration, and spinal cord myelopathy were also reported ( 18 ).…”

“…PET/CT and MRI fusion was done on all patients and used in defining the GTV. SBRT treatment planning was done as previously described, but adjustments were made by the treating physician based on tumor location and proximity of critical structures ( 10 , 11 ). Three-dimensional non-coplanar beam arrangements were custom designed for each case to deliver highly conformal prescription dose distributions.…”

“…Progression-free survival (PFS), locoregional control (LRC), and OS were defined as described ( 10 ). Disease response was assessed according to the response evaluation criteria in solid tumors (RECIST) ( 13 ).…”