Stereotactic Radiosurgery for Tonsillar Carcinoma

Abstract

Background: Stereotactic radiosurgery (SRS) was developed for the treatment of patients with intracranial lesions; indeed, the stereotactic equipment is derived from neurosurgical tools. However, SRS may be feasible for any small lesions that can be targeted with Stereotactic apparatus. In this report we describe the use of SRS in treating a patient with a squamous cell cancer of the oropharynx. Methods: A 62-year-old man had received 65 Gray (Gy) postoperative radiation therapy for a floor of mouth cancer 3 years prior to this presentation. He had developed a second primary of his tonsil within the previous radiation portals. Because of a recent myocardial infarction he was unable to undergo salvage surgery or interstitial brachytherapy. He was unable to have intraoral cone electron beam treatment or contact brachytherapy because of severe trismus. He therefore underwent 30 Gy in 15 fractions of external beam radiation followed by a Stereotactic boost of 850 centigray (cGy) in one fraction. Results: The Stereotactic boost delivered a tumoricidal radiation dose while sparing the mandible and other vital structures. He tolerated the treatment well with a complete local tumor response. Conclusions: In selected patients, stereotactic radiosurgery is a viable option in the management of head and neck cancer.