A simple strategy to decrease fatal carotid blowout syndrome after stereotactic body reirradiaton for recurrent head...

Area of Science:

• Radiation Oncology
• Head and Neck Cancer
• Stereotactic Body Radiotherapy (SBRT)

Background:

• Recurrent head and neck cancer poses significant treatment challenges.
• Stereotactic Body Radiotherapy (SBRT) is an option for inoperable recurrent cases.
• Carotid blow out syndrome (CBOS) is a severe, often fatal, complication of SBRT in this region.

Purpose of the Study:

• To compare therapeutic outcomes between two SBRT protocols for recurrent head and neck cancer.
• To evaluate the incidence of fatal carotid blow out syndrome (CBOS) with different SBRT fractionation schedules.

Main Methods:

• Retrospective analysis of 75 patients with inoperable locally recurrent head and neck cancer treated with SBRT.
• Group I (n=43): Sequential SBRT treatment.
• Group II (n=32): Modified SBRT protocol with treatment delivered every other day, implemented due to high CBOS rates in Group I.

Main Results:

• Median overall survival was significantly longer in Group II (23 months) compared to Group I (11 months) (P=0.006).
• CBOS occurred in 11 patients; survival rates post-CBOS were higher in Group II (50%) vs. Group I (14%).
• CBOS-free median overall survival was 23 months in Group II versus 9 months in Group I (P=0.002); no CBOS occurred with max carotid dose <34 Gy.

Conclusions:

• An every-other-day SBRT protocol shows promise for reducing the incidence of fatal CBOS in re-irradiated head and neck cancer.
• This modified SBRT fractionation may improve survival outcomes while mitigating severe vascular complications.