Stereotactic body radiotherapy for head and neck skin cancer

Published:October 11, 2021DOI:https://doi.org/10.1016/j.radonc.2021.10.004

      Highlights

      • Retrospective review of head and neck skin cancer (HNSC) patients treated with stereotactic body radiation therapy (SBRT).
      • Largest North American experience published in the modern era.
      • SBRT for HNSC provides durable local control rates with acceptable late toxicity rates.

      Abstract

      Aim

      To report outcomes of Stereotactic Body Radiotherapy (SBRT) for head and neck skin cancer (HNSC) patients treated at a high-volume center.

      Materials

      A retrospective review of HNSC SBRT patients from 2012 to 2019 was conducted. Kaplan–Meier method was used to estimate local control (LC), locoregional control (LRC) outside of SBRT field, overall survival (OS), progression-free survival (PFS) and late toxicity (LT). Univariate and multivariate analyses were performed. Grade 3-4 acute and late toxicities were reported by the Common Terminology Criteria for Adverse Events v5.0.

      Results

      One hundred and six medically unfit HNSC patients (112 lesions) were included. Median follow-up was 8 months. Median patient age at diagnosis was 86 years (range: 56–102 years). The majority of patients had advanced disease (overall stage III-IV [n = 90, 85%]) with median gross tumor volumes (GTV) of 31 cm3 (range: 17–56 cm3). Treated sites were: primary (n = 51), nodal (n = 47) or primary plus nodal (n = 8). SBRT doses ranged from 32-50 Gy delivered twice weekly in 4–6 fractions to the gross tumor volume (GTV). One and 2-year LC rates were 78% (69–88) and 67% (53–82), respectively. One-year LRC outside of SBRT field, OS, PFS and LT rates were 72% (62–84), 53% (43–65), 52% (40–62), and 7% (2–17), respectively. Thirty-three patients (31%) developed acute grade ≥ 3 treatment-related toxicity, most commonly dermatitis (n = 31). Nine patients (8%) experienced late grade ≥ 3 toxicity, including 7 grade 3 fibrosis, 1 grade 3 bone radionecrosis and 1 grade 4 skin ulceration. No treatment-related deaths (grade 5) were observed.

      Conclusion

      SBRT provides durable disease control with acceptable toxicity for medically unfit high-risk HNSC patients unable to undergo standard of care curative treatment approaches.

      Keywords

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