Firlik K S, Kondziolka D, Lunsford L D, Janecka I P, Flickinger J C
Department of Neurological Surgery, University of Pittsburgh, Pennsylvania, USA.
Head Neck. 1996 Mar-Apr;18(2):160-5; discussion 166. doi: 10.1002/(SICI)1097-0347(199603/04)18:2<160::AID-HED8>3.0.CO;2-#.
Treatment options for head and neck cancers that recur at the cranial base are limited.
Twelve patients with head and neck cancers recurrent after resection and fractionated radiotherapy (n = 11) at the cranial base had stereotactic radiosurgery using the gamma unit. The median dose to the tumor margin was 16 Gy. Imaging follow-up varied from 3 to 17 months; the longest clinical follow-up was at 35 months.
Three of 8 tumors studied by postradiosurgery imaging remained unchanged in size, 3 decreased, and 2 were no longer visible. There was no morbidity or worsening of symptoms after radiosurgery. Four patients died between 4 and 8 months and did not have postradiosurgery imaging performed. Mean survival after radiosurgery was 10.5 months, with 7 patients (58%) still living.
Radiosurgery proved safe and effective in providing local control for recurrent cranial base cancers arising from the extracranial head and neck. Radiosurgery should be considered for those patients who have failed prior fractionated radiation or surgical resection, those who have tumors in high-risk cranial locations, or those who are poor medical candidates. Although this study shows its potential adjuvant role, longer follow-up and increased clinical experience will be necessary to evaluate the overall role of radiosurgery in head and neck cancer.
颅底复发的头颈部癌治疗选择有限。
12例颅底头颈部癌患者在切除及分次放疗（11例）后复发，接受了伽马刀立体定向放射外科治疗。肿瘤边缘的中位剂量为16 Gy。影像学随访时间为3至17个月；最长临床随访时间为35个月。
放射外科治疗后影像学检查的8个肿瘤中，3个大小无变化，3个缩小，2个消失。放射外科治疗后无并发症或症状恶化。4例患者在4至8个月间死亡，未进行放射外科治疗后的影像学检查。放射外科治疗后的平均生存期为10.5个月，7例患者（58%）仍存活。
放射外科治疗对颅外头颈部复发的颅底癌进行局部控制被证明是安全有效的。对于先前分次放疗或手术切除失败、肿瘤位于颅高风险部位或身体状况较差不适合手术的患者，应考虑放射外科治疗。尽管本研究显示了其潜在的辅助作用，但需要更长时间的随访和更多的临床经验来评估放射外科治疗在头颈部癌中的整体作用。
