Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
Department of Radiotherapy Physics, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
Br J Radiol. 2021 Jan 1;94(1117):20200332. doi: 10.1259/bjr.20200332. Epub 2020 Sep 24.
Stereotactic radiotherapy (SBRT) 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 HNC.
A literature search was performed by using MEDLINE and EMBASE databases for eligible studies from 2000 to 2019 and 26 relevant studies were identified.
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 is a risk as with other forms of reirradiation but alternative treatment regimens may reduce this risk.
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 organ at risk constraints and prescription doses, with accurate plan summation approaches. Prospective randomised trials are warranted to validate improved treatment outcomes and acceptable treatment morbidity.
This article provides a comprehensive review of evidence of use of stereotactic radiotherapy in HNC site (either as a primary treatment or as reirradiation). We also provide an evidence-based approach to the implementation and practical consideration of stereotactic radiotherapy in HNC.
立体定向放疗（SBRT）越来越受欢迎，尽管其在头颈部癌症（HNC）中的应用尚未明确。主要目的是回顾立体定向放疗在 HNC 中的应用的已有文献证据。
使用 MEDLINE 和 EMBASE 数据库对 2000 年至 2019 年期间的合格研究进行了文献检索，共确定了 26 项相关研究。
文献表明，该技术在患者人群、原发性或挽救性治疗、剂量分割方案、结果和随访方案等方面的应用存在异质性。颈动脉破裂综合征是一种风险，与其他形式的再放疗一样，但替代治疗方案可能会降低这种风险。
目前，SBRT 作为 HNC 的主要治疗选择缺乏证据，无法提供关于疗效和耐受性的明确答案，但越来越多的证据表明 SBRT 再放疗方案是安全有效的。在缺乏大型 III 期试验证据的情况下，我们确定了适当的危及器官限制和处方剂量，并采用了准确的计划总和方法。需要进行前瞻性随机试验来验证改善的治疗结果和可接受的治疗发病率。
本文全面回顾了立体定向放疗在 HNC 部位（无论是作为主要治疗还是再放疗）的应用证据。我们还提供了一种基于证据的方法来实施和考虑立体定向放疗在 HNC 中的实际应用。
