Predictive value of skin invasion in recurrent head and neck cancer patients treated by hypofractionated stereotactic re
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RESEARCH
Open Access
Predictive value of skin invasion in recurrent head and neck cancer patients treated by hypofractionated stereotactic re-irradiation using a cyberknife Hideya Yamazaki1,2*, Mikio Ogita3, Kengo Himei4, Satoaki Nakamura1, Gen Suzuki1, Tadayuki Kotsuma5, Ken Yoshida5 and Yasuo Yoshioka6
Abstract Background: This study aimed to elucidate the influence of skin invasion in patients with recurrent head and neck cancer treated with re-irradiation using stereotactic radiotherapy. Materials: We reviewed 104 patients treated using CyberKnife in four institutions. Results: Nine cases of skin invasion were recognized (8.6 %). Larger tumors tended to exhibit skin invasion. The skin invasion (+) group showed a lower response rate (0/9, 0 %) than the skin invasion (−) group (56/95, 59 %) (p = 0.002). The skin invasion (+) group showed lower local control (LC) and progression free survival (PFS) rates, both 0 % at 6 months, than the skin invasion (−) group, which had a LC of 69 % (p = 0.0001) and a PFS of 48 % at 1 year (p = 0.0157). Median survival time and one-year survival rates for the skin invasion (+) and (−) groups were 6.6 vs. 15.3 months and 14 % vs. 59 % (p = 0.0005), respectively. No patient with skin invasion survived more than 14.4 months. The percentage of patients who developed grade 3 or higher toxicity was 44 % in the skin invasion (+) group and 18 % in the skin invasion (−) group (p = 0.14). Conclusions: Skin invasion is an important predictor of poor prognosis in recurrent head and neck cancer after re-irradiation with stereotactic radiation therapy. Keywords: Head Neck cancer, Reirradiation, Stereotactic radiotherapy, CyberKnife, Skin invasion
Background Advanced radiotherapy techniques, i.e., stereotactic body radiation therapy (SBRT), intensity-modulated radiation therapy (IMRT), image-guided external radiotherapy, and new chemotherapeutic agents have improved the outcomes of unresectable head and neck cancer treatments [1, 2]. However, locoregional failure remains a major obstacle and requires further treatment. Unfortunately, one-third of the patients are eligible for salvage surgery [3]. Chemotherapy is frequently preferred, yet it * Correspondence: [email protected] 1 Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan 2 CyberKnife Center, Soseikai General Hospital, 126 Kami-Misu, Shimotoba Fushimi-ku, Kyoto, Japan Full list of author information is available at the end of the article
results in less than 9 months of median survival [4]. With the advancements of modern radiation technique, re-irradiation has become a fascinating optional therapy using advanced technologies, i.e., IMRT and/or SBRT. The image-guided stereotactic radiotherapy system, CyberKnife, enables to deliver precise doses over short treatment periods [5–9]. Several institutions, including ours, reported the outcome and toxicity of re-irradiation using CyberKnife hypofractionated SBRT [5–9].
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