Salvage Reirradiaton With Stereotactic Body Radiotherapy for Locally Recurrent Head-and-Neck Tumors

Cengiz, Mustafa; Özyiğit, Gökhan; Yazıcı, Gözde; Dogan, Ali; Yıldız, Ferah; Zorlu, Faruk; Gurkaynak, M.; Güllü, İbrahi̇m; Hoşal, Şefik; Akyol, Fadıl

doi:10.1016/j.ijrobp.2010.04.027

Cited by 142 publications

(143 citation statements)

References 30 publications

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“…Three out of 32 patients developed CBS with the new treatment strategy with relatively short follow up time. They also mentioned that CBS did not occur in any of the patients with a maximum carotid artery radiation dose of <34 Gy [15].…”

Section: Discussionmentioning

confidence: 99%

Carotid blowout syndrome after intensity-modulated radiation therapy: A case report

Sahin¹,

Atalar²,

Yakupoğlu³

et al. 2017

Marmara Medical Journal

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Carotid blowout syndrome (CBS) is a rarely seen complication of head-neck surgery and radiation therapy. It may present by massive ear bleeding or epistaxis with high morbidity and mortality rates. Success rate of endovascular therapy or emergency surgery is unfortunately low because of massive bleeding and weakened vessel architecture. Here, we present a 45-year-old male with nasopharyngeal carcinoma and treated with intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. The patient was diagnosed with stage III (T3N2M0) carcinoma of the nasopharynx. Eight months after radiotherapy, he was admitted to hospital with the complaint of epistaxis. Right internal carotid angiography revealed a 4 mm pseudoaneurysm at the superioranterior wall of the petrous and his bleeding was controlled by stenting in the same session. In this report we aimed to draw attention to this rare clinical situation that might enhance the chance of early diagnosis enabling less morbid treatment opportunities. Keywords: IMRT, Carotid blowout syndrome, CBS, Pseudoaneurysm ÖZCarotid blowout sendromu (CBS) veya pseudoaneurysm, baş-boyun cerrahisi ve radyoterapi sonrası nadir görülen bir komplikasyondur. Yüksek morbidite ve mortalite oranları ile masif kulak kanaması veya epistaksis şeklinde görülür. Zayıflamış damar yapısı ve masif kanama sebebiyle acil cerrahi ya da endovasküler tedavilerin başarı şansı oldukça düşüktür. Bu yazıda, nazofarenks kanseri tanısı olan ve eş zamanlı kemoterapi ile beraber yoğunluk ayarlı radyoterapi (YART) C alan 3. evre (T3N2M0), 45 yaşında erkek hasta sunulmuştur. Radyoterapi sonrası 8. ayda epistaksis ile hastaneye başvuran hastanın sağ internal carotis arter anjiografisinde petros segmentin antero-superior duvarında 4mm pseudoanevrizma saptanıp aynı seansta stentle kanama kontrolu yapılmıştır. Bu yazıda, erken tanı konulabilmesi ve dolayısıyla daha az morbid tedavi seçeneklerinin sunulabilmesi için nadir görülen bu klinik duruma dikkat çekilmesi amaçlanmıştır.

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Section: Discussionmentioning

confidence: 99%

Carotid blowout syndrome after intensity-modulated radiation therapy: A case report

Sahin¹,

Atalar²,

Yakupoğlu³

et al. 2017

Marmara Medical Journal

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“…Stereotactic radiosurgery has been used for the treatment of skull base tumors over the past few decades and has demonstrated durable tumor control and symptomatic relief with acceptable toxicity in the patients with malignant tumors less than 4 cm in diameter. (18,19) Many researchers have described the utilization of SRT for reirradiation of head and neck tumors, primarily using CyberKnife (Accuray Inc., Sunnyvale, CA) radiosurgery (20)(21)(22)(23)(24) and linac-based SRT. (25,26) Specifically, Unger and colleagues (20) presented a feasibility study reirradiating head and neck cancer patients using CyberKnife technique with fractionated-SRS scheme.…”

Section: Discussionmentioning

confidence: 99%

Monte Carlo evaluation of tissue heterogeneities corrections in the treatment of head and neck cancer patients using stereotactic radiotherapy

Pokhrel

McClinton

Sood

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to generate Monte Carlo computed dose distributions with the X-ray voxel Monte Carlo (XVMC) algorithm in the treatment of head and neck cancer patients using stereotactic radiotherapy (SRT) and compare to heterogeneity corrected pencil-beam (PB-hete) algorithm. This study includes 10 head and neck cancer patients who underwent SRT re-irradiation using heterogeneity corrected pencil-beam (PB-hete) algorithm for dose calculation. Prescription dose was 24-40 Gy in 3-5 fractions (treated 3-5 fractions per week) with at least 95% of the PTV volume receiving 100% of the prescription dose. A stereotactic head and neck localization box was attached to the base of the thermoplastic mask fixation for target localization. The gross tumor volume (GTV) and organs-at-risk (OARs) were contoured on the 3D CT images. The planning target volume (PTV) was generated from the GTV with 0 to 5 mm uniform expansion; PTV ranged from 10.2 to 64.3 cc (average = 35.0±17.5 cc). OARs were contoured on the 3D planning CT and consisted of spinal cord, brainstem, optic structures, parotids, and skin. In the BrainLab treatment planning system (TPS), clinically optimal SRT plans were generated using hybrid planning technique (combination of 3D conformal noncoplanar arcs and nonopposing static beams) for the Novalis-Tx linear accelerator consisting of high-definition multileaf collimators (HD-MLCs: 2.5 mm leaf width at isocenter) and 6 MV-SRS (1000 MU/min) beam. For the purposes of this study, treatment plans were recomputed using XVMC algorithm utilizing identical beam geometry, multileaf positions, and monitor units and compared to the corresponding clinical PB-hete plans. The Monte Carlo calculated dose distributions show small decreases (< 1.5%) in calculated dose for D 99 , D mean , and D max of the PTV coverage between the two algorithms. However, the average target volume encompassed by the prescribed percent dose (V p ) was about 2.5% less with XVMC vs. PB-hete and ranged between -0.1 and 7.8%. The averages for D 100 and D 10 of the GTV were lower by about 2% and ranged between -0.8 and 3.1%. For the spinal cord, both the maximal dose difference and the dose to 0.35 cc of the structure were higher by an average of 4.2% (ranged 1.2 to -13.6%) and 1.4% (ranged 7.5 to -11.3%), respectively, with XVMC calculation. For the brainstem, the maximal dose differences and the dose to 0.5 cc of the structure were, on average, higher by 2.4% (ranged 6.4 to -8.0%) and 3.6% (ranged 6.4 to -9.0%), respectively. For the parotids, both the mean dose and the dose to 20 cc of parotids were higher by an average of 3% (ranged -0.2 to -5.9%) and 4% (ranged -0.2 to -8%), respectively, with XVMC calculation. For the optic apparatus, results from both algorithms were similar. However, the mean dose to skin was 3% higher (ranged 0 to -6%), on average, with XVMC compared to PB-hete, although the maximum dose to skin was 2%

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“…Early grade 3 reactions were diagnosed in 13 patients; late complications (grade 3 and 4) were diagnosed in 3 (8.6%) patients. Cengiz et al used F-SBRT to treat 46 patients diagnosed with unresectable recurrent head and neck cancer [22]. Median total dose was 30 Gy (range 18-35 Gy), delivered mostly in five fractions (range 1-5 fractions).…”

Section: Intensity-modulated Radiotherapy and Stereotactic Body Radiomentioning

confidence: 99%

“…Results from F-SBRT studies: 2-year overall survival was 14.3-40%, local control 40.4%, progression-free survival was 52.2%, frequency of late severe complications was 8.6-14%, frequency of grade 5 complications was 2.8-14% [16,22,23,28] (Table 1). During most of these studies, prognostic factors have been determined which influence the overall survival, locoregional control and progression-free survival; these factors were: longer time interval between initial radiation therapy and reirradiation; chemotherapy or biological therapy, administered in combination Notes: 3D-RT, three-dimensional conformal radiotherapy; 2D-RT, two-dimensional radiotherapy; IMRT, intensitymodulated radiotherapy; CHT, chemotherapy; F-SBRT, fractionated stereotactic body radiation therapy; S-SBRT, radiosurgery; OS, overall survival; LRC, locoregional control; DFS, disease free survival; LC, local control.…”

Section: Intensity-modulated Radiotherapy and Stereotactic Body Radiomentioning

confidence: 99%

“…The results of retrospective studies presented in literature, using reirradiation by three-dimensional radiotherapy (3D-RT) for head and neck cancer recurrence, according to a 2-year overall survival and toxicity, are poor: overall survival reached 15.2-40%, the rate of severe late toxicities (grade 3 and 4) reached 1.4-47%, the rate of degree 5 (lethal) complications reached 7.6% [18][19][20][21]. However, with the advancement of technical measures, after introduction of intensity-modulated radiotherapy (IMRT), fractionated stereotactic body radiation therapy (F-SBRT), high-dose-rate brachytherapy (HDR-BRT), proton beam reirradiation (PBRT), a reirradiation is increasingly more often used for head and neck cancer relapse treatment [6,18,[22][23][24].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Re-irradiation for Recurrent Head and Neck Cancer

Rudžianskas¹,

Kupčinskaitė-Noreikienė²

2017

Radiotherapy

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After radical treatment of head and neck cancer about 20-50% of patients are diagnosed with the locoregional recurrence during first two years. The main treatment for recurrent disease is salvage surgery, but in most cases, surgery is not feasible due to the high risk of complications and morbidity, and only 20% of patients are suitable for surgical salvage. Reirradiation is an effective treatment method with acceptable toxicity, but this treatment method is limited to normal tissue tolerance to a total dose. When chemotherapy is administered for recurrence, the response rate is up to 40%, so with the advancement of technical measures, after introduction of intensity-modulated radiotherapy, fractionated stereotactic body radiation therapy, high-dose-rate brachytherapy, proton beam reirradiation, a reirradiation is increasingly more often used for head and neck cancer relapse treatment. In this chapter, we will discuss about reirradiation with curative intent using new different radiation techniques (intensity-modulated radiotherapy (IMRT), stereotactic body radiation therapy (SBRT), high-dose-rate brachytherapy (HDR-BRT) and proton beam reirradiation (PBRT) for previously irradiated head and neck cancer and present recommendations for retreatment of head and neck cancer relapse using reirradiation alone or with systemic chemotherapy/biologic therapy.

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Salvage Reirradiaton With Stereotactic Body Radiotherapy for Locally Recurrent Head-and-Neck Tumors

Cited by 142 publications

References 30 publications

Carotid blowout syndrome after intensity-modulated radiation therapy: A case report

Carotid blowout syndrome after intensity-modulated radiation therapy: A case report

Monte Carlo evaluation of tissue heterogeneities corrections in the treatment of head and neck cancer patients using stereotactic radiotherapy

Re-irradiation for Recurrent Head and Neck Cancer

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