Patient Outcomes after Reirradiation of Small Skull Base Tumors using Stereotactic Body Radiotherapy, Intensity Modulated Radiotherapy, or Proton Therapy
02 March 2019
11 June 2019
31 July 2019 (online)
Purpose The aim of this study was to evaluate outcomes of patients who received reirradiation for small skull base tumors utilizing either intensity modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT), and proton radiotherapy (PRT).
Methods Patients who received IMRT, SBRT or PRT reirradiation for recurrent or new small skull base tumors (< 60 cc) between April 2000 and July 2016 were identified. Those with < 3 months follow-up were excluded. Clinical outcomes and treatment toxicity were assessed. The Kaplan–Meier method was used to estimate the local control (LC), regional control (RC), distant control (DC), progression free survival (PFS), and overall survival (OS).
Results Of the 75 patients eligible, 30 (40%) received SBRT, 30 (40%) received IMRT, and 15 (20%) received PRT. The median retreatment volume was 28 cc. The median reirradiation dose was 66 Gy in 33 fractions for IMRT/PRT, and 45 Gy in 5 fractions for SBRT. The median time to reirradiation was 41 months. With a median follow-up of 24 months, the LC, RC, DC, PFS, and OS rates were 84%, 79%, 82%, 60%, and 87% at 1 year, and 75%, 72%, 80%, 49%, and 74% at 2 years. There was no difference in OS between radiation modalities. The 1- and 2-year late Grade 3 toxicity rates were 3% and 11% respectively..
Conclusions Reirradiation of small skull base tumors utilizing IMRT, PRT, or SBRT provided good local tumor control and low rates of Grade 3 late toxicity. A prospective clinical trial is needed to guide selection of radiation treatment modalities.
Preliminary data was presented as oral presentations at the Royal Australian and New Zealand College of Radiologists (RANZCR) Annual Scientific Meeting 2017, the Radiological Society of North America (RSNA) 103rd Scientific Assembly and Annual Meeting 2017, and the North American Skull Base Society (NASBS) 28th Annual Meeting 2018.
- 1 Mabanta SR, Mendenhall WM, Stringer SP, Cassisi NJ. Salvage treatment for neck recurrence after irradiation alone for head and neck squamous cell carcinoma with clinically positive neck nodes. Head Neck 1999; 21 (07) 591-594
- 2 Tribius S, Kronemann S, Kilic Y. , et al. Radiochemotherapy including cisplatin alone versus cisplatin + 5-fluorouracil for locally advanced unresectable stage IV squamous cell carcinoma of the head and neck. Strahlenther Onkol 2009; 185 (10) 675-681
- 3 Farrag A, Voordeckers M, Tournel K, De Coninck P, Storme G. Pattern of failure after helical tomotherapy in head and neck cancer. Strahlenther Onkol 2010; 186 (09) 511-516
- 4 Spencer SA, Harris J, Wheeler RH. , et al. Final report of RTOG 9610, a multi-institutional trial of reirradiation and chemotherapy for unresectable recurrent squamous cell carcinoma of the head and neck. Head Neck 2008; 30 (03) 281-288
- 5 Ng SP, Phan J. Stereotactic radiotherapy and proton therapy for locally recurrent head and neck cancer. Austin Head Neck Oncol. 2017; 1: 1002
- 6 Frank SJ, Selek U. Proton beam radiation therapy for head and neck malignancies. Curr Oncol Rep 2010; 12 (03) 202-207
- 7 Phan J, Sio TT, Nguyen TP. , et al. Reirradiation of head and neck cancers with proton therapy: outcomes and analyses. Int J Radiat Oncol Biol Phys 2016; 96 (01) 30-41
- 8 Ho JC, Phan J. Reirradiation of skull base tumors with advanced highly conformal techniques. Curr Oncol Rep 2017; 19 (12) 82
- 9 Lee N, Chan K, Bekelman JE. , et al. Salvage re-irradiation for recurrent head and neck cancer. Int J Radiat Oncol Biol Phys 2007; 68 (03) 731-740
- 10 Curtis KK, Ross HJ, Garrett AL. , et al. Outcomes of patients with loco-regionally recurrent or new primary squamous cell carcinomas of the head and neck treated with curative intent reirradiation at Mayo Clinic. Radiat Oncol 2016; 11: 55
- 11 Romesser PB, Cahlon O, Scher ED. , et al. Proton beam reirradiation for recurrent head and neck cancer: multi-institutional report on feasibility and early outcomes. Int J Radiat Oncol Biol Phys 2016; 95 (01) 386-395
- 12 Riaz N, Hong JC, Sherman EJ. , et al. A nomogram to predict loco-regional control after re-irradiation for head and neck cancer. Radiother Oncol 2014; 111 (03) 382-387
- 13 Baliga S, Kabarriti R, Ohri N. , et al. Stereotactic body radiotherapy for recurrent head and neck cancer: a critical review. Head Neck 2017; 39 (03) 595-601
- 14 Xu KM, Quan K, Clump DA, Ferris RL, Heron DE. Stereotactic ablative radiosurgery for locally advanced or recurrent skull base malignancies with prior external beam radiation therapy. Front Oncol 2015; 5: 65
- 15 Comet B, Kramar A, Faivre-Pierret M. , et al. Salvage stereotactic reirradiation with or without cetuximab for locally recurrent head-and-neck cancer: a feasibility study. Int J Radiat Oncol Biol Phys 2012; 84 (01) 203-209
- 16 Heron DE, Ferris RL, Karamouzis M. , et al. Stereotactic body radiotherapy for recurrent squamous cell carcinoma of the head and neck: results of a phase I dose-escalation trial. Int J Radiat Oncol Biol Phys 2009; 75 (05) 1493-1500
- 17 Roh KW, Jang JS, Kim MS. , et al. Fractionated stereotactic radiotherapy as reirradiation for locally recurrent head and neck cancer. Int J Radiat Oncol Biol Phys 2009; 74 (05) 1348-1355
- 18 Takiar V, Garden AS, Ma D. , et al. Reirradiation of head and neck cancers with intensity modulated radiation therapy: outcomes and analyses. Int J Radiat Oncol Biol Phys 2016; 95 (04) 1117-1131
- 19 Pollard III C, Nguyen TP, Ng SP. , et al. Clinical outcomes after local field conformal reirradiation of patients with retropharyngeal nodal metastasis. Head Neck 2017; 39 (10) 2079-2087
- 20 Cmelak AJ, Cox RS, Adler JR, Fee Jr WE, Goffinet DR. Radiosurgery for skull base malignancies and nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1997; 37 (05) 997-1003
- 21 Miller RC, Foote RL, Coffey RJ. , et al. The role of stereotactic radiosurgery in the treatment of malignant skull base tumors. Int J Radiat Oncol Biol Phys 1997; 39 (05) 977-981
- 22 Coppa ND, Raper DM, Zhang Y. , et al. Treatment of malignant tumors of the skull base with multi-session radiosurgery. J Hematol Oncol 2009; 2: 16
- 23 McDonald MW, Zolali-Meybodi O, Lehnert SJ. , et al. Reirradiation of recurrent and second primary head and neck cancer with proton therapy. Int J Radiat Oncol Biol Phys 2016; 96 (04) 808-819