Abstract
Neck lymph node (LN) recurrence in the irradiated field represents an important aspect of treatment failure after primary radiotherapy owing to the lack of a standard treatment. The aim of this study is to investigate the efficacy and safety of CyberKnife treatment for neck LN recurrence after radiotherapy. Between 2008 and 2016, 55 neck LN recurrences after radiotherapy in 16 patients were treated with CyberKnife. The median follow-up period was 17 months (range, 2–53 months). The median previous radiotherapy dose was 68 Gy (range, 50–70 Gy). The median marginal dose as equivalent dose delivered in 2-Gy fractions (α/β = 10) was 50 Gy (range, 40–58 Gy). The one-year local control (LC) and overall survival rates were 81% and 71%, respectively. The one-year LC was higher with a target volume ≤1.0 cm3 than that with a target volume >1.0 cm3 (p = 0.006). Fatal bleeding was observed in one patient who had large (91 cm3) and widespread tumor with invasion to the carotid artery before CyberKnife treatment. CyberKnife treatment for neck LN recurrence is safe and feasible in most cases. Indication for the treatment should be carefully considered for large and widespread tumors.
Highlights
IntroductionThe standard treatment for inoperable locally advanced head and neck cancers is chemoradiotherapy (CRT) [2,3,4,5], whose efficacy has been proven by a meta-analysis [6,7]
More than 30% of head and neck cancers are diagnosed in advanced stages [1]
The one-year local control (LC) was significantly higher with a target volume ≤1.0 cm3 than with a target volume >1.0 cm3; 95.8% versus 65.9%, respectively (p = 0.006) (Figure 2)
Summary
The standard treatment for inoperable locally advanced head and neck cancers is chemoradiotherapy (CRT) [2,3,4,5], whose efficacy has been proven by a meta-analysis [6,7]. Locoregional recurrence in the head and neck can greatly diminish the quality of life (QOL) of patients with various symptoms including swelling, pain, and pharynx ulceration. Surgical resection as a salvage treatment for locoregional recurrence shows overall survival (OS) rate of 20% at 3 years postoperatively [10]. Salvage surgery is feasible in only 7–27% of patients because of extensive tumor invasion and a high risk of postoperative complications in the irradiated area [10,11,12]. Chemotherapy alone is commonly performed for locoregional recurrence; the median survival after chemotherapy duration is limited to 5–9 months [17,18]
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