Stereotactic Radiosurgery in Treating Patients With Locally Advanced or Recurrent 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.

OBJECTIVES:

* To determine the feasibility and tolerability of CyberKnife® stereotactic radiosurgery as boost therapy after standard chemoradiotherapy in patients with locally advanced head and neck cancer.
* To determine the feasibility and tolerability of CyberKnife® stereotactic radiosurgery as salvage therapy in patients with locally recurrent head and neck cancer.

OUTLINE: Patients are assigned to 1 of 2 treatment groups according to disease status after prior standard therapy. Patients with residual disease after standard therapy are assigned to group 1. Patients with recurrent disease ≥ 6 months after standard therapy are assigned to group 2.

All patients undergo placement of 3-6 gold fiducial markers within 1-2 weeks of beginning CyberKnife® stereotactic radiosurgery (SRS) treatment.

* Group 1 (CyberKnife® SRS boost therapy): Patients undergo CyberKnife® SRS boost therapy (2 fractionated doses) beginning 4-8 weeks after completion of standard therapy.
* Group 2 (CyberKnife® SRS salvage therapy): Patients undergo CyberKnife® SRS salvage therapy (5 fractions) 3 times weekly.

After completion of study treatment, patients are followed periodically for up to 2 years.

Eligibility Criteria:
Inclusion Criteria:

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

Exclusion Criteria:

* No laryngeal or hypopharyngeal cancer
* No evidence of distant metastases
* No prior brachytherapy
* No prior CyberKnife® SRS boost or salvage therapy
* No other malignancy within the past 5 years except basal cell or squamous cell skin cancer or carcinoma in situ of the cervix
* No active connective tissue disorders (e.g., lupus or scleroderma)