The impact of tumor volume and radiotherapy dose on outcome in previously irradiated recurrent squamous cell carcinoma of the head and neck treated with stereotactic body radiation therapy

Jean Claude M Rwigema, Dwight E. Heron, Robert L. Ferris, Regiane S. Andrade, Michael K. Gibson, Yong Yang, Cihat Ozhasoglu, Athanassios E. Argiris, Jennifer R. Grandis, Steven A. Burton

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Purpose: To assess the effect of stereotactic body radiotherapy (SBRT) dose and tumor volume on outcomes in patients with recurrent, previously irradiated squamous cell carcinoma of the head and neck. Materials and Methods: A total of 96 patients with recurrent, previously irradiated squamous cell carcinoma of the head and neck were treated with SBRT using Cyberknife and Trilogy-intensity- modulated radiosurgery. Kaplan-Meier survival analyses were used to estimate locoregional control (LRC) and overall survival rates. Response was evaluated using positron emission tomography/computed tomography or computed tomography and detailed physical examination. Results: The median follow-up for all patients was 14 months (2-39 months). The median dose of prior radiation was 68.4 Gy (32-170 Gy). Patients were divided into 4 SBRT dose groups: I (15-28 Gy/n = 29), II (30-36 Gy/n = 22), III (40 Gy/n = 18), and IV (44-50 Gy/n = 27). The median gross tumor volume (GTV) was 24.3 cm3 (2.5-162 cm). For GTV ≤25 cm3 (n = 50), complete response rates were 27.8%/30%/45.5%/45.5%, and for GTV >25 cm3 (n = 46), complete response rates were 20%/25%/42.8%/50% for SBRT groups I-IV, respectively. The 1-/2-/3-year LRC rates for doses 40 to 50 Gy were 69.4%/57.8%/41.1%, respectively, whereas for 15 to 36 Gy, they were 51.9%/31.7%/15.9%, respectively (P = 0.02). The overall 1- and 2-year overall survival rates were 58.9% and 28.4%, respectively. Treatment was well tolerated with no grade 4/5 toxicities. Conclusions: Dose escalation up to 50 Gy in 5 fractions is feasible with SBRT for recurrent head and neck squamous cell carcinoma. Higher SBRT doses were associated with significantly higher LRC rates. Large tumor volume required higher SBRT doses to achieve optimal response rates compared with smaller tumor volume.

Original languageEnglish (US)
Pages (from-to)372-379
Number of pages8
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume34
Issue number4
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

Radiosurgery
Tumor Burden
Radiotherapy
Survival Rate
Carcinoma, squamous cell of head and neck
Kaplan-Meier Estimate
Survival Analysis
Physical Examination
Tomography
Radiation

Keywords

  • head and neck cancer
  • outcome
  • radiation dose
  • reirradiation
  • stereotactic body radiotherapy
  • tumor volume

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

The impact of tumor volume and radiotherapy dose on outcome in previously irradiated recurrent squamous cell carcinoma of the head and neck treated with stereotactic body radiation therapy. / Rwigema, Jean Claude M; Heron, Dwight E.; Ferris, Robert L.; Andrade, Regiane S.; Gibson, Michael K.; Yang, Yong; Ozhasoglu, Cihat; Argiris, Athanassios E.; Grandis, Jennifer R.; Burton, Steven A.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 34, No. 4, 08.2011, p. 372-379.

Research output: Contribution to journalArticle

Rwigema, Jean Claude M ; Heron, Dwight E. ; Ferris, Robert L. ; Andrade, Regiane S. ; Gibson, Michael K. ; Yang, Yong ; Ozhasoglu, Cihat ; Argiris, Athanassios E. ; Grandis, Jennifer R. ; Burton, Steven A. / The impact of tumor volume and radiotherapy dose on outcome in previously irradiated recurrent squamous cell carcinoma of the head and neck treated with stereotactic body radiation therapy. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2011 ; Vol. 34, No. 4. pp. 372-379.
@article{86998aac1def4968b48caab7613197a2,
title = "The impact of tumor volume and radiotherapy dose on outcome in previously irradiated recurrent squamous cell carcinoma of the head and neck treated with stereotactic body radiation therapy",
abstract = "Purpose: To assess the effect of stereotactic body radiotherapy (SBRT) dose and tumor volume on outcomes in patients with recurrent, previously irradiated squamous cell carcinoma of the head and neck. Materials and Methods: A total of 96 patients with recurrent, previously irradiated squamous cell carcinoma of the head and neck were treated with SBRT using Cyberknife and Trilogy-intensity- modulated radiosurgery. Kaplan-Meier survival analyses were used to estimate locoregional control (LRC) and overall survival rates. Response was evaluated using positron emission tomography/computed tomography or computed tomography and detailed physical examination. Results: The median follow-up for all patients was 14 months (2-39 months). The median dose of prior radiation was 68.4 Gy (32-170 Gy). Patients were divided into 4 SBRT dose groups: I (15-28 Gy/n = 29), II (30-36 Gy/n = 22), III (40 Gy/n = 18), and IV (44-50 Gy/n = 27). The median gross tumor volume (GTV) was 24.3 cm3 (2.5-162 cm). For GTV ≤25 cm3 (n = 50), complete response rates were 27.8{\%}/30{\%}/45.5{\%}/45.5{\%}, and for GTV >25 cm3 (n = 46), complete response rates were 20{\%}/25{\%}/42.8{\%}/50{\%} for SBRT groups I-IV, respectively. The 1-/2-/3-year LRC rates for doses 40 to 50 Gy were 69.4{\%}/57.8{\%}/41.1{\%}, respectively, whereas for 15 to 36 Gy, they were 51.9{\%}/31.7{\%}/15.9{\%}, respectively (P = 0.02). The overall 1- and 2-year overall survival rates were 58.9{\%} and 28.4{\%}, respectively. Treatment was well tolerated with no grade 4/5 toxicities. Conclusions: Dose escalation up to 50 Gy in 5 fractions is feasible with SBRT for recurrent head and neck squamous cell carcinoma. Higher SBRT doses were associated with significantly higher LRC rates. Large tumor volume required higher SBRT doses to achieve optimal response rates compared with smaller tumor volume.",
keywords = "head and neck cancer, outcome, radiation dose, reirradiation, stereotactic body radiotherapy, tumor volume",
author = "Rwigema, {Jean Claude M} and Heron, {Dwight E.} and Ferris, {Robert L.} and Andrade, {Regiane S.} and Gibson, {Michael K.} and Yong Yang and Cihat Ozhasoglu and Argiris, {Athanassios E.} and Grandis, {Jennifer R.} and Burton, {Steven A.}",
year = "2011",
month = "8",
doi = "10.1097/COC.0b013e3181e84dc0",
language = "English (US)",
volume = "34",
pages = "372--379",
journal = "American Journal of Clinical Oncology",
issn = "0277-3732",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - The impact of tumor volume and radiotherapy dose on outcome in previously irradiated recurrent squamous cell carcinoma of the head and neck treated with stereotactic body radiation therapy

AU - Rwigema, Jean Claude M

AU - Heron, Dwight E.

AU - Ferris, Robert L.

AU - Andrade, Regiane S.

AU - Gibson, Michael K.

AU - Yang, Yong

AU - Ozhasoglu, Cihat

AU - Argiris, Athanassios E.

AU - Grandis, Jennifer R.

AU - Burton, Steven A.

PY - 2011/8

Y1 - 2011/8

N2 - Purpose: To assess the effect of stereotactic body radiotherapy (SBRT) dose and tumor volume on outcomes in patients with recurrent, previously irradiated squamous cell carcinoma of the head and neck. Materials and Methods: A total of 96 patients with recurrent, previously irradiated squamous cell carcinoma of the head and neck were treated with SBRT using Cyberknife and Trilogy-intensity- modulated radiosurgery. Kaplan-Meier survival analyses were used to estimate locoregional control (LRC) and overall survival rates. Response was evaluated using positron emission tomography/computed tomography or computed tomography and detailed physical examination. Results: The median follow-up for all patients was 14 months (2-39 months). The median dose of prior radiation was 68.4 Gy (32-170 Gy). Patients were divided into 4 SBRT dose groups: I (15-28 Gy/n = 29), II (30-36 Gy/n = 22), III (40 Gy/n = 18), and IV (44-50 Gy/n = 27). The median gross tumor volume (GTV) was 24.3 cm3 (2.5-162 cm). For GTV ≤25 cm3 (n = 50), complete response rates were 27.8%/30%/45.5%/45.5%, and for GTV >25 cm3 (n = 46), complete response rates were 20%/25%/42.8%/50% for SBRT groups I-IV, respectively. The 1-/2-/3-year LRC rates for doses 40 to 50 Gy were 69.4%/57.8%/41.1%, respectively, whereas for 15 to 36 Gy, they were 51.9%/31.7%/15.9%, respectively (P = 0.02). The overall 1- and 2-year overall survival rates were 58.9% and 28.4%, respectively. Treatment was well tolerated with no grade 4/5 toxicities. Conclusions: Dose escalation up to 50 Gy in 5 fractions is feasible with SBRT for recurrent head and neck squamous cell carcinoma. Higher SBRT doses were associated with significantly higher LRC rates. Large tumor volume required higher SBRT doses to achieve optimal response rates compared with smaller tumor volume.

AB - Purpose: To assess the effect of stereotactic body radiotherapy (SBRT) dose and tumor volume on outcomes in patients with recurrent, previously irradiated squamous cell carcinoma of the head and neck. Materials and Methods: A total of 96 patients with recurrent, previously irradiated squamous cell carcinoma of the head and neck were treated with SBRT using Cyberknife and Trilogy-intensity- modulated radiosurgery. Kaplan-Meier survival analyses were used to estimate locoregional control (LRC) and overall survival rates. Response was evaluated using positron emission tomography/computed tomography or computed tomography and detailed physical examination. Results: The median follow-up for all patients was 14 months (2-39 months). The median dose of prior radiation was 68.4 Gy (32-170 Gy). Patients were divided into 4 SBRT dose groups: I (15-28 Gy/n = 29), II (30-36 Gy/n = 22), III (40 Gy/n = 18), and IV (44-50 Gy/n = 27). The median gross tumor volume (GTV) was 24.3 cm3 (2.5-162 cm). For GTV ≤25 cm3 (n = 50), complete response rates were 27.8%/30%/45.5%/45.5%, and for GTV >25 cm3 (n = 46), complete response rates were 20%/25%/42.8%/50% for SBRT groups I-IV, respectively. The 1-/2-/3-year LRC rates for doses 40 to 50 Gy were 69.4%/57.8%/41.1%, respectively, whereas for 15 to 36 Gy, they were 51.9%/31.7%/15.9%, respectively (P = 0.02). The overall 1- and 2-year overall survival rates were 58.9% and 28.4%, respectively. Treatment was well tolerated with no grade 4/5 toxicities. Conclusions: Dose escalation up to 50 Gy in 5 fractions is feasible with SBRT for recurrent head and neck squamous cell carcinoma. Higher SBRT doses were associated with significantly higher LRC rates. Large tumor volume required higher SBRT doses to achieve optimal response rates compared with smaller tumor volume.

KW - head and neck cancer

KW - outcome

KW - radiation dose

KW - reirradiation

KW - stereotactic body radiotherapy

KW - tumor volume

UR - http://www.scopus.com/inward/record.url?scp=79961172037&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79961172037&partnerID=8YFLogxK

U2 - 10.1097/COC.0b013e3181e84dc0

DO - 10.1097/COC.0b013e3181e84dc0

M3 - Article

C2 - 20859194

AN - SCOPUS:79961172037

VL - 34

SP - 372

EP - 379

JO - American Journal of Clinical Oncology

JF - American Journal of Clinical Oncology

SN - 0277-3732

IS - 4

ER -