CK for head and neck cancer: 2nd National Congress of AIRO Giovani, Florence Italy - June 27, 2009

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>>CK for head and neck cancer: 2nd National Congress of AIRO Giovani, Florence Italy - June 27, 2009

An event organized by the Directorate of AIRO Giovani

AIRO Giovani Coordinator and organizer of the congress: L. Livi (Firenze)
Scientific responsible of the congress: B. De Bari (Lione)
Scientific Committee: A. Filippi (Torino), V. D’Emilio (Ragusa), M.A. Gambacorta (Roma), L. Livi (Firenze), P. Murino (Napoli)

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THE ROLE OF CYBERKNIFE IN THE TREATMENT AND RETREATMENT OF HEAD AND NECK CANCER. OUR EXPERIENCE.

A. Pontoriero, D. Arpa, P. Frosina, C. De Renzis.

*Department of Radiological Science, Operative Unit of Radiotherapy University of Messina.

OBJECTIVE:
To determine the efficacy of Cyberknife, new frameless imagine-guided, for primary and recurrent head and neck carcinomas.

MATERIALS AND METHODS:
Between July 2007 and April 2009, 12 patients with a median age of 59 years (range 25-72 ) were treated by Cyberknife stereotactic radiosurgery for head and neck cancers. There were 7 female ( 58,4 %) and 5 male (41,6%). The principal primitive tumors responsible of the lesions have been: nasopharyngeal cancer ( 4 cases), lacrimal gland cancer(2), minor salivary gland cancer(1), plasmocitoma(3), tonsil cancer (1), LNH ( 1) . In our centre, we have treated six ( 6 ) primary sites of desease ( orbit, skull-base, maxillary sinus and clivus) and six ( 6 ) locally recurrent HNC (sphenoid sinus, nasopharyngeal and lymphnodes). Three patients were reirradiated and one received concomitant cetuximab (400 mg/mq the week before the start of radiotherapy and 250mg/mq weekly during four weeks). Median dose prescribed was 20,5 Gy( range15-36 Gy); the median prescription isodose was typically 75%( range 60-83 % ) ; the treatment was fractionated for ten patients and in single fraction for two patients. The median target volume was 12,47 cc (range 1,3 -55,5 cc). Non-isocentric conformal treatment plan were used for all patients. Tracking with Xsight Spine or 6D skull was systematically used. Median follow-up was 21months.

RESULTS:
At three months, six patients had complete regression of the lesions after CKSRS, five had partial response, and one had progression of disease. The overall response rate was 99 %. CK-SRS and FSRT established ultimate disease control in 99 % of the patients.

CONCLUSION:
Our early results is encouraging that CK SRS and FSRT are an effective
treatment modality with acceptable morbidity for salvage treatment of HCN. Hypofractionated stereotactic radiotherapy is a new potentially curative therapeutic option for reirradiation of head and neck carcinomas. The Cyberknife offers an alternative therapeutic modality for treatment of skull-base tumors in case in which surgery cannot be performed or located in critical area.

However, more experience and longer follow-up with increased number of patients would be necessary to determined the role of fractionated stereotactic radiosurgery in this group of patients.