Stereotactic Body Radiotherapy in the Management of Head and Neck Malignancies

Technological advancements in robotics, imaging and stereotactic localization have made extracranial radiosurgery possible. Stereotactic body radiation therapy (SBRT) utilizes specially modified linear accelerators to deliver radiation to precisely defined anatomic targets. Radiation is delivered in one to five fractions at high doses per fraction compared to conventional radiation therapy techniques. SBRT was first utilized to treat lesions of the lungs, liver, pancreas and spine but in recent years, there has been a growing body of literature describing the use of this technique in head and neck cancer amongst others. These studies indicate that the treatment is well-tolerated by patients, and in the setting of recurrent head and neck cancer is similar in efficacy to other non-surgical salvage strategies. Optimization of treatment parameters has led to improvements in tumor control while reducing the already low rates of severe chronic toxicities. The promising results to date suggest that SBRT may play an increasing role in the therapeutic armamentarium in head and neck cancer.