IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies : A Case Series
Patients with high risk salivary gland malignancies are at increased risk of local failure. We present our institutional experience with dose escalation using hypofractionated Stereotactic Body Radiotherapy (SBRT) in a subset of this rare disease. Over the course of 9 years, 10 patients presenting...
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2014-10-01
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| Series: | Frontiers in Oncology |
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| Online Access: | http://journal.frontiersin.org/Journal/10.3389/fonc.2014.00268/full |
| _version_ | 1831835859347832832 |
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| author | Sana D Karam Abdul eRashid James W Snider Margaux eWooster Shilpa eBhatia Ann K Jay Kenneth eNewkirk Bruce eDavidson K. William eHarter |
| author_facet | Sana D Karam Abdul eRashid James W Snider Margaux eWooster Shilpa eBhatia Ann K Jay Kenneth eNewkirk Bruce eDavidson K. William eHarter |
| author_sort | Sana D Karam |
| collection | DOAJ |
| description | Patients with high risk salivary gland malignancies are at increased risk of local failure. We present our institutional experience with dose escalation using hypofractionated Stereotactic Body Radiotherapy (SBRT) in a subset of this rare disease. Over the course of 9 years, 10 patients presenting with skull base invasion, gross disease with one or more adverse features, or those treated with adjuvant radiation with three or more pathologic features were treated with intensity modulated radiation therapy followed by hypofractionated SBRT boost. Patients presented with variable tumor histologies, and in all but one, the tumors were classified as poorly differentiated high grade. Four patients had gross disease, 3 had gross residual disease, 3 had skull base invasion, and 2 patients had rapidly recurrent disease (≤ 6 months) that had been previously treated with surgical resection. The median Stereotactic Radiosurgery boost dose was 17.5 Gy (range 10-30 Gy) given in a median of 5 fractions (range 3-6 fractions) for a total median cumulative dose of 81.2 Gy (range 73.2-95.6 Gy). The majority of the patients received platinum based concurrent chemotherapy with their radiation. At a median follow-up of 32 months (range 12-120) for all patients and 43 months for surviving patients (range 12-120), actuarial 3-year locoregional control, distant control, progression free survival, and overall survival were 88%, 81%, 68%, and 79%, respectively. Only one patient failed locally and two failed distantly. Serious late toxicity included graft ulceration in 1 patient and osteoradionecrosis in another patient, both of which underwent surgical reconstruction. Six patients developed fibrosis. In a subset of patients with salivary gland malignancies with skull base invasion, gross disease, or those treated adjuvantly with three or more adverse pathologic features, hypofractionated SBRT boost to Intensity Modulated Radiotherapy yields good local control rates and acceptable toxicit |
| first_indexed | 2024-12-23T04:45:41Z |
| format | Article |
| id | doaj.art-1f51b05f73404c3ebb3851fea5040893 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-23T04:45:41Z |
| publishDate | 2014-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-1f51b05f73404c3ebb3851fea50408932022-12-21T17:59:39ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2014-10-01410.3389/fonc.2014.0026897561IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies : A Case SeriesSana D Karam0Abdul eRashid1James W Snider2Margaux eWooster3Shilpa eBhatia4Ann K Jay5Kenneth eNewkirk6Bruce eDavidson7K. William eHarter8University of ColoradoGeorgetown University HospitalUniversity of MarylandGeorgetown University HospitalUniversity of ColoradoGeorgetown University HospitalGeorgetown University HospitalGeorgetown University HospitalGeorgetown University HospitalPatients with high risk salivary gland malignancies are at increased risk of local failure. We present our institutional experience with dose escalation using hypofractionated Stereotactic Body Radiotherapy (SBRT) in a subset of this rare disease. Over the course of 9 years, 10 patients presenting with skull base invasion, gross disease with one or more adverse features, or those treated with adjuvant radiation with three or more pathologic features were treated with intensity modulated radiation therapy followed by hypofractionated SBRT boost. Patients presented with variable tumor histologies, and in all but one, the tumors were classified as poorly differentiated high grade. Four patients had gross disease, 3 had gross residual disease, 3 had skull base invasion, and 2 patients had rapidly recurrent disease (≤ 6 months) that had been previously treated with surgical resection. The median Stereotactic Radiosurgery boost dose was 17.5 Gy (range 10-30 Gy) given in a median of 5 fractions (range 3-6 fractions) for a total median cumulative dose of 81.2 Gy (range 73.2-95.6 Gy). The majority of the patients received platinum based concurrent chemotherapy with their radiation. At a median follow-up of 32 months (range 12-120) for all patients and 43 months for surviving patients (range 12-120), actuarial 3-year locoregional control, distant control, progression free survival, and overall survival were 88%, 81%, 68%, and 79%, respectively. Only one patient failed locally and two failed distantly. Serious late toxicity included graft ulceration in 1 patient and osteoradionecrosis in another patient, both of which underwent surgical reconstruction. Six patients developed fibrosis. In a subset of patients with salivary gland malignancies with skull base invasion, gross disease, or those treated adjuvantly with three or more adverse pathologic features, hypofractionated SBRT boost to Intensity Modulated Radiotherapy yields good local control rates and acceptable toxicithttp://journal.frontiersin.org/Journal/10.3389/fonc.2014.00268/fullSalivary Gland NeoplasmsCyberKnifeSBRTSRSparotid |
| spellingShingle | Sana D Karam Abdul eRashid James W Snider Margaux eWooster Shilpa eBhatia Ann K Jay Kenneth eNewkirk Bruce eDavidson K. William eHarter IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies : A Case Series Frontiers in Oncology Salivary Gland Neoplasms CyberKnife SBRT SRS parotid |
| title | IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies : A Case Series |
| title_full | IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies : A Case Series |
| title_fullStr | IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies : A Case Series |
| title_full_unstemmed | IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies : A Case Series |
| title_short | IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies : A Case Series |
| title_sort | imrt with stereotactic body radiotherapy boost for high risk malignant salivary gland malignancies a case series |
| topic | Salivary Gland Neoplasms CyberKnife SBRT SRS parotid |
| url | http://journal.frontiersin.org/Journal/10.3389/fonc.2014.00268/full |
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