The Feasibility and Outcome of Cyberknife® Stereotactic Radiosurgical Boost and Salvage Therapy for Head and Neck Cancer
RATIONALE: Stereotactic radiosurgery may be able to send x-rays directly to the tumor and cause less damage to normal tissue. PURPOSE: This phase I trial is studying the side effects of stereotactic radiosurgery in treating patients with locally advanced or recurrent head and neck cancer.
• DISEASE CHARACTERISTICS:
• Biopsy-confirmed* invasive head and neck cancer, including the following primary sites:
• Nasopharynx
• Oropharynx
• Paranasal sinus
• Oral cavity
• Orbit
• Salivary gland NOTE: *Biopsy must be performed prior to initiation of external beam radiotherapy (EBRT)
• Stage T2-4 tumor at the time of diagnosis
• Primary tumor ≤ 5 cm in diameter at the time of CyberKnife® stereotactic radiosurgery (SRS)
• Meets one of the following criteria:
• Eligible for CyberKnife® SRS as boost therapy, as defined by one of the following criteria:
• Planning to undergo definitive EBRT, with or without chemotherapy, with curative intent for primary head and neck cancer
• Biopsy-confirmed locally persistent disease < 3 months after completion of definitive EBRT
• Eligible for CyberKnife® SRS as salvage therapy*, as defined by one of the following criteria:
• Biopsy-confirmed locally recurrent disease occurring ≥ 6 months after the completion of radiotherapy; achieved a complete response to initial therapy by imaging or clinical examination; had > 50% of the tumor volume in the prior irradiated volume; and received > 45 Gy of radiotherapy
• Biopsy-confirmed locally recurrent disease occurring between 6 weeks and 6 months after the completion of radiotherapy; achieved a complete response to initial therapy by imaging or clinical examination; had < 50% of the tumor volume in the prior irradiated volume; and received > 45 Gy of radiotherapy NOTE: *Not a candidate for salvage surgery or brachytherapy
• Anticipated total dose of radiotherapy to the spinal cord ≤ 50 Gy (including prior dose)
• PATIENT CHARACTERISTICS:
• Karnofsky performance status 60-100%
• Not pregnant or nursing
• Fertile patients must use effective contraception
• Able to achieve normal tissue tolerance to critical structures with the CyberKnife® planning system
• Able to undergo CT simulation
• PRIOR CONCURRENT THERAPY:
• See Disease Characteristics