Background and objectives: The aim of this study is to examine the effect of Image-guided stereotactic radiotherapy (IGSRT) in the treatment of advanced, recurrent lesions for head and neck carcinoma both with and without lymph node involvement.

Methods: Between April 2006 and July 2007, 22 patients (mean age 67 years) with advanced, recurrent head and neck carcinoma were treated with IGSRT by CyberKnife-II. Patients included 3 rT2, 8 rT3, and 9 rT4; 8 of the patients had lymph node metastases. Marginal irradiated doses were 20–42 Gy delivered in two to five fractions. Starting one month after IGSRT, all patients received S-1 oral chemotherapy for one year. Treatment outcome was assessed based on the Response Evaluation Criteria in Solid Tumors, (RECIST) Version 1.1. Toxicities were graded using Common Terminology Criteria for Adverse Event (CTCAE) Version 4.03. Overall survival was determined by Kaplan–Meier survival analysis.

Results: At an overall median follow-up of 67 months (range, 4–80 months), for the 14 locally recurrent patients without lymph node metastases, 9 patients (64.3%) had a complete response (CR), 1 patient (7.1%) had a partial response (PR), 1 patient (7.1%) had stable disease (SD), and 3 patients (21.4%) had progressive disease (PD). For the 8 patients with lymph node metastases, 1 patient with a single retropharyngeal (12.5%) had CR; the remaining 7 patients (87.5%) all progressed. Nine patients have died from their cancer. The overall 5-year survival for the patients with and without lymph node metastases was 12.5% and 78.6% ( p = 0.0000019 by log-rank test). Three of the patients who had previously received external beam radiation experienced Grade 2 osteoradionecrosis for 10–18 months.

Conclusions: These results show the benefit of local control by IGSRT using CyberKnife combined with S-1 Oral chemotherapy for advanced, recurrent lesions, without lymph node metastases in previously irradiated head and neck cancer.