A systematic review and practical considerations of stereotactic body radiotherapy in the treatment of head and neck cancer

Head and Neck Cancer

Br J Radiol. 2020 Sep 22:20200332. doi: 10.1259/bjr.20200332. Online ahead of print.


OBJECTIVES: Stereotactic radiotherapy is gaining popularity although its use in head and neck cancer (HNC) is not well defined. The primary objective was to review the published evidence regarding the use of stereotactic radiotherapy in head and neck cancer.

METHODS: A literature search was performed by using MEDLINE and EMBASE databases for eligible studies from 2000 to 2019 and 26 relevant studies were identified.

RESULTS: Literature demonstrates a heterogeneous use of this technique with regards to patient population, primary or salvage treatment, dose fractionation regimens, outcomes and follow up protocols. Carotid blow out syndrome (CBOS) is a risk as with other forms of reirradiation but alternative treatment regimens may reduce this risk.

CONCLUSION: At present there is a lack of evidence regarding SBRT as a primary treatment option for HNC and definitive answers regarding efficacy and tolerability cannot be provided but there is growing evidence that SBRT reirradiation regimens are safe and effective. In lieu of evidence from large Phase III trials, we define appropriate OAR constraints and prescription doses, with accurate plan summation approaches. Prospective randomised trials are warranted to validate improved treatment

outcomes and acceptable treatment morbidity.

ADVANCES IN KNOWLEDGE: This article provides a comprehensive review of evidence of use of stereotactic radiotherapy in head and neck cancer site (either as a primary treatment or as re-irradiation). We also provide an evidence-based approach to the implementation and practical consideration of stereotactic radiotherapy in head and neck cancer.