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. 2017 Sep;7(3):336-340.
doi: 10.3892/mco.2017.1339. Epub 2017 Jul 24.

Effect of intratumoral abscess/necrosis on the outcome for head and neck cancer patients treated by hypofractionated stereotactic re-irradiation using CyberKnife®

Hideya Yamazaki  1   2 , Mikio Ogita  3 , Kengo Himei  4 , Satoaki Nakamura  1 , Gen Suzuki  1 , Tadayuki Kotsuma  5 , Ken Yoshida  5 , Yasuo Yoshioka  6
Affiliations

Effect of intratumoral abscess/necrosis on the outcome for head and neck cancer patients treated by hypofractionated stereotactic re-irradiation using CyberKnife®

Hideya Yamazaki et al. Mol Clin Oncol. 2017 Sep.

Abstract

The aim of the present study was to elucidate the effect of intratumoral abscess/necrosis (AN) on the outcome of patients with recurrent head and neck cancer (HNC) treated by stereotactic radiotherapy. The records of 67 patients treated with CyberKnife® in four institutes between August 2000 and July 2010 were reviewed. The frequency of AN appeared to be increased in younger postoperative patients with large ulcerative tumors. The AN+ group exhibited a better initial response rate compared with the AN- group (64 vs. 33%, respectively; P=0.04). The 1-year local control rate was 51 and 75% in the AN+ and AN- groups, respectively (P=0.01), while the respective 1-year overall survival rates were 53 and and 71% (P=0.0004). A total of 21 patients (31%) experienced grade ≥3 toxicities, and carotid blowout syndrome (CBOS) was found in 11 patients, resulting in 8 deaths. A significantly larger proportion of patients in the AN+ group developed CBOS (8/18; 44%) compared with the AN- group (3/49; 6%) (P=0.001). Therefore, AN may be an important prognostic factor for patients with recurrent HNC, as well as a predictor of lethal toxicity due to CBOS.

Keywords: CyberKnife; abscess necrosis; carotid blowout syndrome; head neck cancer; reirradiation; stereotactic radiotherapy.

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Figures

Figure 1.
Figure 1.
Presentation of a case with intratumoral abscess/necrosis. A 61-year-old man with oropharyngeal cancer (right lateral wall) underwent preoperative radiotherapy at 40 Gy in 20 fractions with intra-arterial chemotherapy (cisplatin) followed by surgery (primary cancer and right neck dissection) and was pathologically classified as T3N0. A recurrent tumor was detected at the primary site with subsequent extension to the Rouvière node 4 months later. The patient then received CyberKnife® hypofractionated stereotactic radiation therapy with 37 Gy administered in 10 fractions. The patient exhibited an intratumoral abscess/necrosis (arrow) with ulceration with a planning target volume of 132 cm3. One month after treatment, the patient developed carotid blowout syndrome and succumbed within 1 day.
Figure 2.
Figure 2.
Effect of intratumoral AN on the outcome for patients with head and neck cancer. Solid line, AN− cases; broken line, AN+ cases. (A) Local control rate, (B) overall survival rate and (C) CBOS-free survival rate depending on the presence of AN. AN, abscess/necrosis; CBOS, carotid blowout syndrome.
See this image and copyright information in PMC

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