Robotic radiosurgery for severe recurrent and primary head and neck cancer

Abstract

e17038 Background: We considered the functional reconstruction following head and neck tumor ablation, however, it was impossible to recover completely the function against the severe postoperative status. Here we describe our aim to improve local control and to obtain organ preservation by using the non-surgical outpatient procedure the CyberKnife frameless radiosurgery (CK). Methods: Between March 2006 and January 2008, 22 patients with severe recurrent, previously treated with conventional methods, and 14 patients with primary lesions were treated with CK in the management of head and neck cancer. All the patients had biopsy confirmation of disease prior to radiation therapy; rT2 (3 patients), rT3 (8), rT4 (9), T2 (5), T3 (3), T4 (6), N1 (4), N2b (3), M1 (1), tongue (11), mandibule (11), maxilla (6), maxillary sinus (4), soft palate (2), with sq. cell ca.(34), adenoid cystic ca.(1), fibrosarcoma (1). The treatment plan was set up based on CT, MRI and PET-CT in Yokohama CyberKnife Center. CK's lightweight linear accelerator always irradiates toward the target from 120 directions with image-guided computer based on CT. Marginal Doses were 2000–4200cGy in 3–5 fractions. Curative effects were evaluated assessed by RECIST included PET. Results: 11/22 (50.0%) of the severe recurrent cases were controlled from 6 to 25 months at follow-up range. The local recurrent cases with non-lymph node metastases were excellently controlled as 10/12 (83.3%). For the primary cases, significant tumor reduction were noted at the third-month follow-up, all the 14 patients went into remission with 5 cases in CR, and 9 cases in PR. Between the 4–6 month follow-up, 4 cases were performed additional CK treatment for the recurrent lesions, however, 3 patients with T4 tongue cancer were not cured. Finally, the total control rate of the primary cases was 10/14 (71.4%), however, 8/9 (88.9%) primary cases except tongue cancer has been controlled treated by CK with chemotherapy. The cases of non-lymph node metastases were cured 8/8 (100.0%) by CK. There have been no seriously complications of treatment caused by CK except severe osteoradionecrosis of the 4 patients irradiated with maximum dose. Conclusions: It is now possible with the development of CyberKnife Radiosurgery to improve our treatments of the local control in head and neck cancer. No significant financial relationships to disclose.