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Clinical outcomes of single or oligo-fractionated stereotactic radiotherapy for head and neck tumors using micromultileaf collimator-based dynamic conformal arcs

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Abstract

Purpose

To assess the clinical outcomes of single or oligo-fractionated stereotactic radiotherapy (SRT) using dynamic conformal arcs (DCA) for head and neck tumors (HNTs).

Methods

Thirty-four consecutive patients with 35 lesions treated between 2005 and 2009 were retrospectively evaluated, of whom 85.7 % had recurrent or metastatic disease, and 45.7 and 34.3 % had previous radiotherapy and surgery, respectively. The median SRT dose was 22.3 Gy (11.2–32.8) in 2–4 fractions with a median interval of 7 days and 10.4 Gy (9.2–12.4) in one fraction. SRT was combined with upfront conventionally fractionated RT in 48.6 % of patients.

Results

The median follow-up periods were 18.4 months (2–84.1) for the entire cohort and 49.6 months for the survivors. The 1- and 2-year local control (LC) rates were 84.3 and 70.5 %, with the 1- and 2-year overall survival (OS) rates of 78.6 and 51.6 %. LC was significantly better for tumor volumes <25.6 cm3 (p = 0.001). OS was significantly longer in patients without any disease outside the SRT site (p < 0.001), whereas LC after the SRT did not affect the OS. Late adverse events occurred in 9 patients, including cranial nerve (CN) injury (grade 3/4) in 2, brain radionecrosis in 5 (grade 1), and fatal bleeding in 2 patients harboring uncontrolled lesions abutting the carotid artery.

Conclusions

DCA-based SRT can confer relatively long-term LC with acceptable toxicity in selected patients with HNTs. The patients with CN involvement or tumor volume ≥25.6 cm3 were deemed unsuitable for this treatment regimen.

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Authors and Affiliations

  1. Department of Radiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan

    Kazuhiro Ohtakara, Shinya Hayashi, Sunaho Okada & Hiroaki Hoshi

  2. Department of Otolaryngology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan

    Keisuke Mizuta, Mitsuhiro Aoki, Kenichi Ando & Yatsuji Ito

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  1. Kazuhiro Ohtakara
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  2. Shinya Hayashi
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  3. Keisuke Mizuta
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Correspondence to Kazuhiro Ohtakara.

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Ohtakara, K., Hayashi, S., Mizuta, K. et al. Clinical outcomes of single or oligo-fractionated stereotactic radiotherapy for head and neck tumors using micromultileaf collimator-based dynamic conformal arcs. J Cancer Res Clin Oncol 138, 1511–1522 (2012). https://doi.org/10.1007/s00432-012-1225-z

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  • DOI: https://doi.org/10.1007/s00432-012-1225-z

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