Stereotactic body radiation therapy in head and neck, gynecologic, and pediatric malignancies

Stereotactic body radiotherapy (SBRT) is increasingly being used in the clinic. While most data from this new technology has been in the treatment of early stage lung cancer and sites of oligometastasis in the lung, liver or bone, limited experience exists in other disease sites. Recently, more and more physicians are using SBRT for retreatment. In the head and neck, multiple articles have now been published reporting outcomes in patients with recurrence or those with new primary lesions in previously irradiated areas. The response rates to SBRT have been good; however, long-term control and toxicity are still a major problem. In gynecological malignancies, the literature on SBRT is more limited with initial experience treating para-aortic nodal metastasis from cervical and uterine cancer with excellent local control. Current studies are underway utilizing SBRT with the inclusion of chemotherapy in the treatment regimen of metastatic gynecologic cancers. In pediatrics, where problems of late toxicity are a concern, there is scant information. With all these advances, long-term follow-up is needed to look at complication rates with this form of treatment. In this review, we will discuss the rationale and possible applications of SBRT in head and neck, gynecological, and pediatric tumors. We will outline the advantages and disadvantages including possible complications of SBRT. We will also present some illustrative cases on how we have used this technology in our practice.