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Stereotactic body radiotherapy for distant metastases to the head and neck

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Abstract

Purpose

To report clinical outcomes for patients with metastatic disease to the head and neck (HN) treated with stereotactic body radiation therapy (SBRT).

Methods

A retrospective review of patients treated with SBRT to HN sites from 2012 to 2020 was conducted. Treatment indications included the following: oligometastases, oligoprogression, and control a dominant area of progression (DAP). Kaplan–Meier method was used to estimate local control (LC), regional control (RC), overall survival (OS), and progression-free survival (PFS). Univariable (UVA) and multivariable analyses (MVA) were performed. Grade 3–4 acute and late toxicities were reported by the Common Terminology Criteria for Adverse Events v5.0.

Results

Fifty-six patients (58 lesions) were analysed with a median follow-up of 16 months. Primary sites included lung (25.0%), kidney (19.6%), breast (19.6%) and other (35.8%). SBRT indications were as follows: oligometastases (42.9%), oligoprogression (19.6%) and local control of a dominant area of progression (37.5%). Most patients received SBRT to a single neck node (n = 47, 81.0%). Median SBRT dose was 40 Gy (range 25–50 Gy) in five fractions, with a median biologically effective dose (BED10) of 72 Gy (range 37.5–100 Gy). One- and 2-year LC and RC rates were 97.6% and 72.7% as well as 100% and 86.7%, respectively. Median OS was 19.2 months (95% [CI] 14.8–69.4), and median PFS was 7.4 months (95% [CI] 5.2–11.9). The 1-year OS and PFS rates for oligometastases, oligoprogression and DAP were 95.8%, 63.6% and 38.1% (p = 0.0039) as well as 56.5%, 27.3% and 19.1% (p = 0.0004), respectively. On MVA, treatment indication and histology were predictive for OS, while indication and prior systemic therapy were predictive for PFS. Cumulative late grade 3 + toxicity rate was 11.3%, without grade 5 events.

Conclusion

The use of SBRT for metastatic disease to the HN provided excellent LC rates with low rates of regional failure and an acceptable toxicity profile, highlighting its utility in these patients. Patients with oligometastatic disease had better OS and PFS than others.

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Authors and Affiliations

  1. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Adam Mutsaers, Ahmed Abugharib, Ian Poon, Joshua Loblaw, Andrew Bayley, Liying Zhang, Arjun Sahgal & Irene Karam

  2. Department of Clinical Oncology, Sohag University, Sohag, Egypt

    Ahmed Abugharib

  3. Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Lee Chin

  4. Department of Radiation Therapy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Madette Galapin & Darby Erler

  5. Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Kevin Higgins, Danny Enepekides & Antoine Eskander

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  1. Adam Mutsaers
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Contributions

A.S. reports a research grant from Elekta AB; receiving honoraria from AstraZeneca, Varian (CNS Teaching Faculty), BrainLAB, and Medtronic Kyphon; being on the medical advisory group for Varian and Gamma Knife Icon for Elekta; being a consultant for Brain LAB; and is an International Society of Stereotactic Radiosurgery (ISRS) member and co-chair (AO Spine KFT). I.P. reports honoraria from Sanofi Aventis and Astra Zeneca outside the submitted work.

Corresponding author

Correspondence to Irene Karam.

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Competing interests

A.S. reports a research grant from Elekta AB; receiving honoraria from AstraZeneca, Varian (CNS Teaching Faculty), BrainLAB, and Medtronic Kyphon; being on the medical advisory group for Varian and Gamma Knife Icon for Elekta; being a consultant for Brain LAB; and is an International Society of Stereotactic Radiosurgery (ISRS) member and co-chair (AO Spine KFT). I.P. reports honoraria from Sanofi Aventis and Astra Zeneca outside the submitted work.

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Mutsaers, A., Abugharib, A., Poon, I. et al. Stereotactic body radiotherapy for distant metastases to the head and neck. Support Care Cancer 32, 230 (2024). https://doi.org/10.1007/s00520-024-08419-0

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