Stereotactic Body Radiation Therapy for Primary, Recurrent, and Metastatic Tumors in the Head-and-Neck Region

Siddiqui, Farzan; Patel, Mehul; Khan, Mohammad Javed; McLean, Scott A.; Dragovic, Jadranka; Jin, Jian; Movsas, Benjamin; Ryu, Samuel

doi:10.1016/j.ijrobp.2008.09.022

Cited by 131 publications

(112 citation statements)

References 29 publications

(30 reference statements)

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“…With wider availability of radio-surgery systems, there has been recent renewed interest in using either single-fraction short-course hypo-fractionated stereotactic body radiotherapy (SBRT) for head-neck cancers. In a recent report, 82 55 lesions arising in the head-neck in 44 patients as primary, recurrent, or metastatic cancers were treated using single-dose (13-18 Gy) or hypo-fractionated SBRT (36-48 Gy in 5-8 fractions). Tumor control at 1-year was 83.3% and 60.6% in the primary and recurrent groups respectively, with only grade 1-2 acute mucosal toxicity.…”

Section: Radio-surgerymentioning

confidence: 99%

IMRT and IGRT in head and neck cancer: Have we delivered what we promised?

Gupta

Agarwal

Susovan

et al. 2010

Indian J Surg Oncol

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Intensity-modulated radiation therapy (IMRT) is a revolutionary new paradigm that aims at improving the therapeutic ratio by increasing the dosegradient between target tissues and surrounding normal structures thereby offering probability of better loco-regional control with decreased risk of complications. IMRT is relatively intolerant to set-up uncertainties, warranting periodic image-guidance, making Image-Guided Radiation Therapy (IGRT) a natural corollary to IMRT. There are several challenges associated with the planning, delivery, and quality assurance of the IMRT and IGRT processes that must be addressed to realize the full potential of such exciting and promising technology. Given the complexities involved, it is quite intuitive to understand that IMRT and IGRT are resource-intensive, demanding increased labor, rigour, and expenses too. Other disadvantages associated with high-precision techniques include potentially increased risk of marginal failures, decreased dose homogeneity, and an increase in total body dose with increased risk of secondary carcinogenesis. The aim of this review is to define the role of IMRT and IGRT in contemporary head and neck oncologic practice through a critical appraisal of pertinent literature. Despite relatively short follow-up and limited clinical outcomes data, the weight of evidence suggests that loco-regional control is not inferior (either comparable or even better) and toxicity lesser with IMRT resulting in potentially improved quality-oflife, prompting the widespread adoption of such technology in community practice. Ongoing clinical trials in head and neck IMRT are currently addressing issues to optimize the IMRT process, adopting functional imaging for dose-painting, and incorporating adaptive re-planning strategies to further improve outcomes.

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Section: Radio-surgerymentioning

confidence: 99%

IMRT and IGRT in head and neck cancer: Have we delivered what we promised?

Gupta

Agarwal

Susovan

et al. 2010

Indian J Surg Oncol

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“…Stereotactic body radiotherapy in HNC can be delivered by LINAC gantry-based systems using relocatable, noninvasive, stereotactic frame localization 52 and also robotic radiosurgery systems. Robotic radiosurgery systems such as the CyberKnife mount a lightweight 6-MV LINAC on a robotic arm capable of motion with 6 degrees of freedom.…”

Section: Salvage Options For Recurrent Hncmentioning

confidence: 99%

“…52 Fractionated SBRT was used in 37 patients and the remainder received single-dose SBRT. Indications for using SBRT as the primary treatment in this study included comorbidities that precluded patients from undergoing surgery, conventional radiation, or refusal of another form of treatment.…”

Section: Salvage Options For Recurrent Hncmentioning

confidence: 99%

“…24 After defining the GTV, a clinical target volume may be defined to account for potential subclinical disease and a PTV margin to account for treatment setup. In most patient series, 34,52 no additional margins were created to account for setup error, because the SBRT systems used were within submillimeter accuracy. In the patient series studied by Roh et al, 51 a margin of 2-3 mm beyond the FDG PET avid tumor was used to account for subclinical disease or potential internal organ motion.…”

Section: Defining the Target Volumementioning

confidence: 99%

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Emerging applications of stereotactic radiotherapy in head and neck cancer

Truong

Grillone²,

Tschoe

et al. 2009

FOC

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Advances in the management of locally advanced head and neck cancer (HNC) have been focused on treatment intensification, including concomitant chemoradiotherapy, biological agents, and combining surgery with chemoradiotherapy. Despite these improvements, locoregional recurrence still constitutes the main pattern of treatment failure. As improvements in radiotherapy delivery and image-guided therapy have come to fruition, the principles of stereotactic radiosurgery are now being applied to extracranial sites, leading to stereotactic body radiotherapy. This article focuses on the emerging evidence for the use of stereotactic body radiotherapy for treatment of HNC as a boost after conventional external-beam radiotherapy, and also as reirradiation in recurrent or second primary HNC.

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“…Stereotactic body radiation therapy (SBRT), however, is much more complicated due to motion of targets and normal tissues. SBRT is used in the treatment of a wide range of tumor sites, including lung [1], liver [2], pancreas [3], prostate [4], spine [5], head-and-neck [6] and some other sites [7][8][9][10][11][12]. A variety of techniques have been reported to address this issue; these techniques for improvement of accuracy and precision can be classified into two broad categories: immobilization and motion reduction techniques, and image guidance.…”

Section: Introductionmentioning

confidence: 99%

Motion Management in Stereotactic Body Radiotherapy

Zhang

Yu²,

Stevens³

et al. 2013

J Nucl Med Radiat Ther

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With the technologic advancements in image guidance and dose delivery, stereotactic body radiotherapy (SBRT) is being widely used for cancer treatment in various anatomical locations as a noninvasive alternative to surgery. To deliver ablative doses to tumors with limited normal tissue toxicity, SBRT requires high accuracy in treatment setup which requires taking tumor motion into account. Techniques are also applied in SBRT to minimize tumor motion during dose delivery. This paper reviews techniques for motion management in SBRT.

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Stereotactic Body Radiation Therapy for Primary, Recurrent, and Metastatic Tumors in the Head-and-Neck Region

Cited by 131 publications

References 29 publications

IMRT and IGRT in head and neck cancer: Have we delivered what we promised?

IMRT and IGRT in head and neck cancer: Have we delivered what we promised?

Emerging applications of stereotactic radiotherapy in head and neck cancer

Motion Management in Stereotactic Body Radiotherapy

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