- Email: [email protected]
Radiosurgical treatment of maxillary squamous cell carcinoma
Chin shield osteotomy – a new genioplasty technique avoiding a deep mento-labial fold in order 9. Frodel JL, Sykes JM, Jones JL. Evaluation and treatment of vertical microgenia. Arch Facial Plast Surg 2004: 6: 111–119. 10. Lazar F, Zur Hausen M, Siessegger A, Mischkowski R, Zoller JE. [Mucocele of the chin area. A rare complication after genioplasty with osteocartilagenous nasal bone transplant. Review of the literature and case report]. Mund Kiefer Gesichtschir 2003: 7: 380–385. 11. Matarasso A, Elias AC, Elias RL. Labial incompetence: a marker for progressive bone resorption in silastic chin augmentation: an update. Plast Reconstr Surg 2003: 112: 676–678. 12. Matarasso A, Elias AC, Elias RL. Labial incompetence: a marker for progressive bone resorption in silastic chin augmentation. Plast Reconstr Surg 1996: 98: 1007–1014. 13. Polido WD, de Clairefont Regis L, Bell WH. Bone resorption, stability, and soft-tissue changes following large chin advancements. J Oral Maxillofac Surg 1991: 49: 251–256. 14. Robinson M, Shuken R. Bone resorption under plastic chin implants. J Oral Surg 1969: 27: 116–118.
15. Rosen HM. Aesthetic refinements in genioplasty: the role of the labiomental fold. Plast Reconstr Surg 1991: 88: 760–767. 16. Rosen HM. Aesthetic guidelines in genioplasty: the role of facial disproportion. Plast Reconstr Surg 1995: 95: 463–469. 17. Saleh HA, Lohuis PJ, Vuyk HD. Bone resorption after alloplastic augmentation of the mandible. Clin Otolaryngol 2002: 27: 129–132. 18. Shelly AD, Southard TE, Southard KA, Casko JS, Jakobsen JR, Fridrich KL, Mergen JL. Evaluation of profile esthetic change with mandibular advancement surgery. Am J Orthod Dentofacial Orthop 2000: 117: 630–637. 19. Shoshani Y, Chaushu G, Taicher S. The influence of the osteotomy slope on bony changes after advancement genioplasty. J Oral Maxillofac Surg 1998: 56: 919–922. 20. Stanton DC, Genioplasty. Facial Plast Surg 2003: 19: 75–86. 21. Triaca A, Minoretti R, Merz B. Treatment of mandibular retrusion by distraction osteogenesis: a new technique. Br J Oral Maxillofac Surg 2004: 42: 89–95.
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22. Veltkamp T, Buschang PH, English JD, Bates J, Schow SR. Predicting lower lip and chin response to mandibular advancement and genioplasty. Am J Orthod Dentofacial Orthop 2002: 122: 627–634. 23. Viterbo F. Chin augmentation with conchal cartilage. Plast Reconstr Surg 2003: 111: 899–903. 24. Zide BM, Pfeifer TM, Longaker MT. Chin surgery: I. Augmentation-the allures and the alerts. Plast Reconstr Surg 1999: 104: 1843–1853. 25. Zide BM, Boutros S. Chin surgery III: revelations. Plast Reconstr Surg 2003: 111: 1542–1550. Address: Dr. Albino Triaca Center for Maxillofacial Surgery Pyramide Clinic Bellerivestr. 34 CH-8034 Zurich/Switzerland Tel.: +41 44 3881488 fax: +41 44 3881499 E-mail: [email protected] doi:10.1016/j.ijom.2009.05.013
Technical Note Head and Neck Oncology
Radiosurgical treatment of maxillary squamous cell carcinoma
K. Kawaguchi1, H. Yamada1, A. Horie1, K. Sato2 1 Department of Oral and Maxillofacial Surgery, Tsurumi University School of Dental Medicine, Yokohama, Japan; 2Yokahama CyberKnife Center, Yokohama, Japan
K. Kawaguchi, H. Yamada, A. Horie, K. Sato: . Int. J. Oral Maxillofac. Surg. 2009; 38: 1201–1225. # 2009 . Published by Elsevier Ltd. All rights reserved. Abstract. The authors report their experience of using the CyberKnife1 system (Accuray Incorporated, Sunnyvale, California, USA), a new radiosurgical device, as a treatment option for squamous cell carcinoma (SCC) of the maxillary sinus. A 66-year-old man with SCC stage T4 was treated using the CyberKnife system.
Most squamous cell carcinomas (SCCs) of the head and neck region present at an advanced stage and are treated with a combined approach including surgery, radiation therapy and chemotherapy. Recently, stereotactic radiosurgery sys-
tems, such as the CyberKnife1,7,10 have been introduced (Fig. 1). The CyberKnife is a whole-body image-guided robotic radiosurgery system. The CyberKnife image guidance system includes two orthogonally situated kilovoltage X-ray
Keywords: maxillary sinus; radiosurgery; squamous cell carcinoma. Accepted for publication 3 June 2009 Available online 3 July 2009
imaging sources and corresponding amorphous silicon detectors that work with a computed tomography (CT) image obtained before surgery, which is used to provide digitally reconstructed radiographs. Interplay between the image
1206
Kawaguchi et al.
Fig. 1. CyberKnife system.
guidance system, an automated couch, and a compact linear accelerator mounted on an agile robotic arm, allows the real-time tracking of the target. The robotic manipulator, attached to the linear accelerator, can move in six degrees of freedom and the overall targeting error of the entire system is less than 1 mm. The lightweight linear accelerator can irradiate the target from 120 different directions. It is directed by a treatment plan that relies on CT or a combination of CT and magnetic resonance (MR) images.2,3,7 The CyberKnife system differs from other image-guided radiosurgery/therapy devices because it is not attached to a gantry system and it can target outside a 3608 radius, this gives it potential advantages regarding the distribution of the dose and thus clinical outcome and toxicity. Strategies employing fractionation with up to five radiosurgery sessions (fractions) have been used to treat tumors adjacent to sensitive structures or the spinal cord. Fractionation allows time for normal tissue repair, and leads to better protection of normal structures.4 Recently, CyberKnife treatment has been used for brain tumors12, spinal tumors,1 lung cancers11 and trigeminal neuralgia by rhizotomy of the trigeminal nerve6. In head and neck cancer, a few studies5,10 have investigated the feasibility and clinical outcome of CyberKnife radiosurgery, but the treatment of locally advanced tumors extending to the skull base with conventionally fractionated external beam radiotherapy is a clinical challenge. Based on the promising outcome and toxicity profile of the reported studies, the authors examined the feasibility and potential advantage of this technology in their area of expertise. They report their experience with CyberKnife radiosurgery in the treat-
ment of a case of SCC of the maxillary sinus. Technical Case Report
A 66-year-old man was referred for treatment of a mass in the left maxilla. The patient had been experiencing discomfort with his maxillary denture for a month. A positron emission tomography (PET) scan demonstrated high uptake of 18F-fluorodeoxyglucose (FDG) in the mass of the left maxillary sinus, which was in contact with the skull base. The standard uptake value of FDG was 33.7, suggesting an aggressive malignant tumor (Fig. 2A). Clinical examination, including biopsy, revealed SCC of the left maxillary sinus of stage T4. Neither distant nor regional lymph node metastases were found. The standard treatment option was surgery followed by chemotherapy and/or radiotherapy, but the patient rejected hospital admission. Therefore CyberKnife radiosurgery, a non-surgical outpatient procedure, was
recommended and carried out. Before the treatment a customized face mask was made to immobilize the head. A radiation oncologist created a treatment plan based on the tumor location assessed by CT and MRI. A dose of 40 Gy in 5 fractions was administered to the tumor, which had a diameter of 46.51 mm. The outcome of the treatment was assessed using the Response Evaluation Criteria in Solid Tumors 9. At the 1-month follow-up the lesion had shrunk, which was assessed as a partial response. At the 4-month follow-up the lesion had disappeared, which was evaluated as a complete response. 1 week after CyberKnife radiotherapy, mucositis was detected and assessed as Grade 2 according to the Common Terminology Criteria for Adverse Events v.3.0, but it resolved within 3 weeks following conservative treatment. There was no other acute or chronic toxicity during or following CyberKnife radiotherapy. No evidence of recurrence was noted at follow-up examinations at 24 and 32 months according to PET-CT imaging (Fig. 2B). Discussion
Conventional treatment for SCC of the maxillary sinus is surgery followed by chemotherapy and/or radiotherapy. JANSEN et al reported that radiotherapy and debulking surgery followed by high-dose radiotherapy was associated with better survival4. Recently, the CyberKnife image-guided radiosurgical system has been evaluated as a treatment option10. In contrast to the more established Gamma Knife1 (Elekta AB, Stockholm, Sweden) the beam delivery of the CyberKnife can be non-isocentric, thanks to the high degree of mobility of the robotic
Fig. 2. (A) Preoperative scan demonstrating high uptake of 18F-FDG in the mass located in the left maxillary sinus, which is in contact with the skull base (arrowheads). (B) 2 years after CyberKnife radiosurgery, a PET scan demonstrated no uptake of 18F-FDG in the left maxillary sinus.
Radiosurgical treatment of maxillary SCC manipulator7. In the present case CyberKnife radiosurgery resulted in a remarkably good clinical outcome and the tumor shrank markedly in 1 month. At the 4month follow-up the lesion had disappeared macroscopically. VOYNOV et al10 reported that CyberKnife treatment (median dose: 24 Gy) is well tolerated with one case each of Grade 2 and Grade 3 mucositis among 22 patients with recurrent SCC of the head and neck. In the present case, the patient experienced moderate oral mucositis of Grade 2, which might have been caused by the relatively high total dose of 40 Gy, but the lesion resolved without aftereffects. Stereotactic radiosurgery has shown clinical efficacy in the treatment of head and neck cancers in both primary8 and recurrent applications.5,10 LE et al5 reported that stereotactic radiosurgery, including the CyberKnife System as a boost after 66 Gy conventional external beam radiotherapy, produced a 100% 3year local control rate in 45 patients with nasopharyngeal carcinoma. In a series of 22 cases of recurrent nasopharyngeal carcinoma CyberKnife radiosurgery achieved only a 26% 2-year local control rate, although most patients experienced palliation10. The local control rate is influenced by various factors, including tumor stage, tumor volume, adequacy of the irradiation dose, prior treatment, and anatomical site, the indication for CyberKnife radiosurgery for tumors in the oral and maxillofacial region has not been clearly defined, but it has potential for the treatment of benign or malignant tumors in locations difficult to access surgically. In conclusion, the authors introduced the CyberKnife radiosurgery system as a treatment alternative to oral and maxillofacial surgery and presented a successfully treated case. CyberKnife radiosurgery is a new and promising treatment for head and neck cancers. The efficacy of CyberKnife radiosurgery should be evaluated including its safety and patient satisfaction.
Funding
None. Competing interests
None declared. Ethical approval
Not required. References 1. Bhatnagar AK, Gerszten PC, Ozhasoglu C, Vogel WJ, Kalnicki S, Welch WC, Burton SA. CyberKnife Frameless Radiosurgery for the treatment of extracranial benign tumors. Technol Cancer Res Treat 2005: 4: 571–576. 2. Gibbs IC, Chang SD, Adler Jr JR, CyberKnife radiosurgery experience at Stanford university. In: Mould RF, ed: Robotic Radiosurgery, Vol. 1. Sunnyvale, California: The CyberKnife Society Press 2005 : 33–35. 3. Hara W, Soltys SG, Gibbs IC, Iris. CyberKnife robotic radiosurgery system for tumor treatment. Expert Rev Anticancer Ther 2007: 7: 1507–1515. 4. Jansen EP, Keus RB, Hilgers FJ, Haas RL, Tan IB, Bartelink H. Does the combination of radiotherapy and debulking surgery favor survival in paranasal sinus carcinoma? Int J Radiat Oncol Bio Phys 2000: 48: 24–35. 5. Le QT, Tate D, Koong A, Gibbs IC, Chang SD, Adler JR, Pinto HA, Terris DJ, Fee WE, Goffinet DR. Improved local control with stereotactic radiosurgical boost in patients with nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2003: 56: 1046–1054. 6. Patil CG, Veeravagu A, Bower RS, Li G, Chang SD, Lim M, Adler Jr JR. CyberKnife radiosurgical rhizotomy for the treatment of atypical trigeminal nerve pain. Neurosurg Focus 2007: 23: E9. 7. Romanelli P, Schaal DW, Adler JR. Image-guided radiosurgical ablation of intra- and extra-cranial lesions. Technol Cancer Res Treat 2006: 5: 421–428.
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8. Tate DJ, Adler Jr JR, Chang SD, Marquez S, Eulau SM, Fee WE, Pinto H, Goffinet DR. Stereotactic radiosurgical boost following radiotherapy in primary nasopharyngeal carcinoma: impact on local control. Int J Radiat Oncol Biol Phys 1999: 45: 915–921. 9. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000: 92: 205–216. 10. Voynov G, Heron DE, Burton S, Grandis J, Quinn A, Ferris R, Ozhasoglu C, Vogel W, Johnson J. Frameless stereotactic radiosurgery for recurrent head and neck carcinoma. Technol Cancer Res Treat 2006: 5: 529–535. 11. Whyte RI, Crownover R, Murphy MJ, Martin DP, Rice TW, DeCamp Jr MM, Rodebaugh R, Weinhous MS, Le QT. Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial. Ann Thorac Surg 2003: 75: 1097– 1101. 12. Yoshikawa K, Saito K, Kajiwara K, Nomura S, Ishihara H, Suzuki M. CyberKnife stereotactic radiotherapy for patients with malignant glioma. Minim Invasive Neurosurg 2006: 49: 110–115. Address: Koji Kawaguchi Department of Oral and Maxillofacial Surgery Tsurumi University School of Dental Medicine 2-1-3 Tsurumi, Tsurumi-ku Yokohama 230-8501 Japan Tel: +81 45 581 1001 Fax: +81 45 582 0459 E-mail: [email protected] doi:10.1016/j.ijom.2009.06.003
15. Rosen HM. Aesthetic refinements in genioplasty: the role of the labiomental fold. Plast Reconstr Surg 1991: 88: 760–767. 16. Rosen HM. Aesthetic guidelines in genioplasty: the role of facial disproportion. Plast Reconstr Surg 1995: 95: 463–469. 17. Saleh HA, Lohuis PJ, Vuyk HD. Bone resorption after alloplastic augmentation of the mandible. Clin Otolaryngol 2002: 27: 129–132. 18. Shelly AD, Southard TE, Southard KA, Casko JS, Jakobsen JR, Fridrich KL, Mergen JL. Evaluation of profile esthetic change with mandibular advancement surgery. Am J Orthod Dentofacial Orthop 2000: 117: 630–637. 19. Shoshani Y, Chaushu G, Taicher S. The influence of the osteotomy slope on bony changes after advancement genioplasty. J Oral Maxillofac Surg 1998: 56: 919–922. 20. Stanton DC, Genioplasty. Facial Plast Surg 2003: 19: 75–86. 21. Triaca A, Minoretti R, Merz B. Treatment of mandibular retrusion by distraction osteogenesis: a new technique. Br J Oral Maxillofac Surg 2004: 42: 89–95.
1205
22. Veltkamp T, Buschang PH, English JD, Bates J, Schow SR. Predicting lower lip and chin response to mandibular advancement and genioplasty. Am J Orthod Dentofacial Orthop 2002: 122: 627–634. 23. Viterbo F. Chin augmentation with conchal cartilage. Plast Reconstr Surg 2003: 111: 899–903. 24. Zide BM, Pfeifer TM, Longaker MT. Chin surgery: I. Augmentation-the allures and the alerts. Plast Reconstr Surg 1999: 104: 1843–1853. 25. Zide BM, Boutros S. Chin surgery III: revelations. Plast Reconstr Surg 2003: 111: 1542–1550. Address: Dr. Albino Triaca Center for Maxillofacial Surgery Pyramide Clinic Bellerivestr. 34 CH-8034 Zurich/Switzerland Tel.: +41 44 3881488 fax: +41 44 3881499 E-mail: [email protected] doi:10.1016/j.ijom.2009.05.013
Technical Note Head and Neck Oncology
Radiosurgical treatment of maxillary squamous cell carcinoma
K. Kawaguchi1, H. Yamada1, A. Horie1, K. Sato2 1 Department of Oral and Maxillofacial Surgery, Tsurumi University School of Dental Medicine, Yokohama, Japan; 2Yokahama CyberKnife Center, Yokohama, Japan
K. Kawaguchi, H. Yamada, A. Horie, K. Sato: . Int. J. Oral Maxillofac. Surg. 2009; 38: 1201–1225. # 2009 . Published by Elsevier Ltd. All rights reserved. Abstract. The authors report their experience of using the CyberKnife1 system (Accuray Incorporated, Sunnyvale, California, USA), a new radiosurgical device, as a treatment option for squamous cell carcinoma (SCC) of the maxillary sinus. A 66-year-old man with SCC stage T4 was treated using the CyberKnife system.
Most squamous cell carcinomas (SCCs) of the head and neck region present at an advanced stage and are treated with a combined approach including surgery, radiation therapy and chemotherapy. Recently, stereotactic radiosurgery sys-
tems, such as the CyberKnife1,7,10 have been introduced (Fig. 1). The CyberKnife is a whole-body image-guided robotic radiosurgery system. The CyberKnife image guidance system includes two orthogonally situated kilovoltage X-ray
Keywords: maxillary sinus; radiosurgery; squamous cell carcinoma. Accepted for publication 3 June 2009 Available online 3 July 2009
imaging sources and corresponding amorphous silicon detectors that work with a computed tomography (CT) image obtained before surgery, which is used to provide digitally reconstructed radiographs. Interplay between the image
1206
Kawaguchi et al.
Fig. 1. CyberKnife system.
guidance system, an automated couch, and a compact linear accelerator mounted on an agile robotic arm, allows the real-time tracking of the target. The robotic manipulator, attached to the linear accelerator, can move in six degrees of freedom and the overall targeting error of the entire system is less than 1 mm. The lightweight linear accelerator can irradiate the target from 120 different directions. It is directed by a treatment plan that relies on CT or a combination of CT and magnetic resonance (MR) images.2,3,7 The CyberKnife system differs from other image-guided radiosurgery/therapy devices because it is not attached to a gantry system and it can target outside a 3608 radius, this gives it potential advantages regarding the distribution of the dose and thus clinical outcome and toxicity. Strategies employing fractionation with up to five radiosurgery sessions (fractions) have been used to treat tumors adjacent to sensitive structures or the spinal cord. Fractionation allows time for normal tissue repair, and leads to better protection of normal structures.4 Recently, CyberKnife treatment has been used for brain tumors12, spinal tumors,1 lung cancers11 and trigeminal neuralgia by rhizotomy of the trigeminal nerve6. In head and neck cancer, a few studies5,10 have investigated the feasibility and clinical outcome of CyberKnife radiosurgery, but the treatment of locally advanced tumors extending to the skull base with conventionally fractionated external beam radiotherapy is a clinical challenge. Based on the promising outcome and toxicity profile of the reported studies, the authors examined the feasibility and potential advantage of this technology in their area of expertise. They report their experience with CyberKnife radiosurgery in the treat-
ment of a case of SCC of the maxillary sinus. Technical Case Report
A 66-year-old man was referred for treatment of a mass in the left maxilla. The patient had been experiencing discomfort with his maxillary denture for a month. A positron emission tomography (PET) scan demonstrated high uptake of 18F-fluorodeoxyglucose (FDG) in the mass of the left maxillary sinus, which was in contact with the skull base. The standard uptake value of FDG was 33.7, suggesting an aggressive malignant tumor (Fig. 2A). Clinical examination, including biopsy, revealed SCC of the left maxillary sinus of stage T4. Neither distant nor regional lymph node metastases were found. The standard treatment option was surgery followed by chemotherapy and/or radiotherapy, but the patient rejected hospital admission. Therefore CyberKnife radiosurgery, a non-surgical outpatient procedure, was
recommended and carried out. Before the treatment a customized face mask was made to immobilize the head. A radiation oncologist created a treatment plan based on the tumor location assessed by CT and MRI. A dose of 40 Gy in 5 fractions was administered to the tumor, which had a diameter of 46.51 mm. The outcome of the treatment was assessed using the Response Evaluation Criteria in Solid Tumors 9. At the 1-month follow-up the lesion had shrunk, which was assessed as a partial response. At the 4-month follow-up the lesion had disappeared, which was evaluated as a complete response. 1 week after CyberKnife radiotherapy, mucositis was detected and assessed as Grade 2 according to the Common Terminology Criteria for Adverse Events v.3.0, but it resolved within 3 weeks following conservative treatment. There was no other acute or chronic toxicity during or following CyberKnife radiotherapy. No evidence of recurrence was noted at follow-up examinations at 24 and 32 months according to PET-CT imaging (Fig. 2B). Discussion
Conventional treatment for SCC of the maxillary sinus is surgery followed by chemotherapy and/or radiotherapy. JANSEN et al reported that radiotherapy and debulking surgery followed by high-dose radiotherapy was associated with better survival4. Recently, the CyberKnife image-guided radiosurgical system has been evaluated as a treatment option10. In contrast to the more established Gamma Knife1 (Elekta AB, Stockholm, Sweden) the beam delivery of the CyberKnife can be non-isocentric, thanks to the high degree of mobility of the robotic
Fig. 2. (A) Preoperative scan demonstrating high uptake of 18F-FDG in the mass located in the left maxillary sinus, which is in contact with the skull base (arrowheads). (B) 2 years after CyberKnife radiosurgery, a PET scan demonstrated no uptake of 18F-FDG in the left maxillary sinus.
Radiosurgical treatment of maxillary SCC manipulator7. In the present case CyberKnife radiosurgery resulted in a remarkably good clinical outcome and the tumor shrank markedly in 1 month. At the 4month follow-up the lesion had disappeared macroscopically. VOYNOV et al10 reported that CyberKnife treatment (median dose: 24 Gy) is well tolerated with one case each of Grade 2 and Grade 3 mucositis among 22 patients with recurrent SCC of the head and neck. In the present case, the patient experienced moderate oral mucositis of Grade 2, which might have been caused by the relatively high total dose of 40 Gy, but the lesion resolved without aftereffects. Stereotactic radiosurgery has shown clinical efficacy in the treatment of head and neck cancers in both primary8 and recurrent applications.5,10 LE et al5 reported that stereotactic radiosurgery, including the CyberKnife System as a boost after 66 Gy conventional external beam radiotherapy, produced a 100% 3year local control rate in 45 patients with nasopharyngeal carcinoma. In a series of 22 cases of recurrent nasopharyngeal carcinoma CyberKnife radiosurgery achieved only a 26% 2-year local control rate, although most patients experienced palliation10. The local control rate is influenced by various factors, including tumor stage, tumor volume, adequacy of the irradiation dose, prior treatment, and anatomical site, the indication for CyberKnife radiosurgery for tumors in the oral and maxillofacial region has not been clearly defined, but it has potential for the treatment of benign or malignant tumors in locations difficult to access surgically. In conclusion, the authors introduced the CyberKnife radiosurgery system as a treatment alternative to oral and maxillofacial surgery and presented a successfully treated case. CyberKnife radiosurgery is a new and promising treatment for head and neck cancers. The efficacy of CyberKnife radiosurgery should be evaluated including its safety and patient satisfaction.
Funding
None. Competing interests
None declared. Ethical approval
Not required. References 1. Bhatnagar AK, Gerszten PC, Ozhasoglu C, Vogel WJ, Kalnicki S, Welch WC, Burton SA. CyberKnife Frameless Radiosurgery for the treatment of extracranial benign tumors. Technol Cancer Res Treat 2005: 4: 571–576. 2. Gibbs IC, Chang SD, Adler Jr JR, CyberKnife radiosurgery experience at Stanford university. In: Mould RF, ed: Robotic Radiosurgery, Vol. 1. Sunnyvale, California: The CyberKnife Society Press 2005 : 33–35. 3. Hara W, Soltys SG, Gibbs IC, Iris. CyberKnife robotic radiosurgery system for tumor treatment. Expert Rev Anticancer Ther 2007: 7: 1507–1515. 4. Jansen EP, Keus RB, Hilgers FJ, Haas RL, Tan IB, Bartelink H. Does the combination of radiotherapy and debulking surgery favor survival in paranasal sinus carcinoma? Int J Radiat Oncol Bio Phys 2000: 48: 24–35. 5. Le QT, Tate D, Koong A, Gibbs IC, Chang SD, Adler JR, Pinto HA, Terris DJ, Fee WE, Goffinet DR. Improved local control with stereotactic radiosurgical boost in patients with nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2003: 56: 1046–1054. 6. Patil CG, Veeravagu A, Bower RS, Li G, Chang SD, Lim M, Adler Jr JR. CyberKnife radiosurgical rhizotomy for the treatment of atypical trigeminal nerve pain. Neurosurg Focus 2007: 23: E9. 7. Romanelli P, Schaal DW, Adler JR. Image-guided radiosurgical ablation of intra- and extra-cranial lesions. Technol Cancer Res Treat 2006: 5: 421–428.
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8. Tate DJ, Adler Jr JR, Chang SD, Marquez S, Eulau SM, Fee WE, Pinto H, Goffinet DR. Stereotactic radiosurgical boost following radiotherapy in primary nasopharyngeal carcinoma: impact on local control. Int J Radiat Oncol Biol Phys 1999: 45: 915–921. 9. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000: 92: 205–216. 10. Voynov G, Heron DE, Burton S, Grandis J, Quinn A, Ferris R, Ozhasoglu C, Vogel W, Johnson J. Frameless stereotactic radiosurgery for recurrent head and neck carcinoma. Technol Cancer Res Treat 2006: 5: 529–535. 11. Whyte RI, Crownover R, Murphy MJ, Martin DP, Rice TW, DeCamp Jr MM, Rodebaugh R, Weinhous MS, Le QT. Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial. Ann Thorac Surg 2003: 75: 1097– 1101. 12. Yoshikawa K, Saito K, Kajiwara K, Nomura S, Ishihara H, Suzuki M. CyberKnife stereotactic radiotherapy for patients with malignant glioma. Minim Invasive Neurosurg 2006: 49: 110–115. Address: Koji Kawaguchi Department of Oral and Maxillofacial Surgery Tsurumi University School of Dental Medicine 2-1-3 Tsurumi, Tsurumi-ku Yokohama 230-8501 Japan Tel: +81 45 581 1001 Fax: +81 45 582 0459 E-mail: [email protected] doi:10.1016/j.ijom.2009.06.003