Advances In Radiotherapy For Head And Neck Cancer

Modern Radiotherapy (RT) plays a key role in the management of Head and Neck Cancer (HNC). More precise delivery techniques, advanced image-guidance, and adaptive treatments characterize modern RT, enabling safer treatments with enhanced therapeutic window. Although patients identify the cure as their most important treatment outcome, complications related to treatment are a recognized problem as follow-up increases among those cured within this oncologic setting. This is particularly relevant for HPV-related oropharyngeal cancer (OPSCC), as these patients are younger, healthier, and more reactive to treatment. Thus, given the longer life expectancy, the jeopardizing impact of side effects on quality of life (QoL) and psychosocial functioning represent a forefront topic for HNC Researchers. De-escalation protocols have been developed recently, and, although not definitive, evidence is growing. This pertains particularly, but not exclusively, to HPV-related OPSCC.

Cancers of the head and neck are among the most morbid of cancers. Convention al surgery and/or radiation therapy have a high cure rate for patients with early stage disease. However, despite optimal treatment with surgery and radiotherapy, patients with nodal spread or extensive local disease have a low cure rate. Even if a cancer is cured, a patient is often left with long-term debilities from the treatment and/or cancer. The major causes for decreased survival in patients with advanced head and neck cancer include local recurrence, distant metastases, and second primaries. All of these need to be addressed if one is to improve upon the curability of advanced disease. There are several new techniques, surgical and radiotherapeutic, designed to improve local control. Brachytherapy, or interstitial implantation, delivers a high dose of localized radiation with minimal normal tissue injury. This technique as discussed by Goffinet, may be even more efficacious when combined with hyperthermia. New, creative methods of radiation therapy delivery, such as the use of multiple fractions per day, as discussed by Parsons and Million, are also contributing to long-term local control. Laser therapy, discussed by Ossoff and Nemeroff, provides another tool for treatment of local disease.

The contemporary management of patients with cancers of the head and neck is under careful scrutiny and major changes are being introduced in order to improve the potenti al not only for long-term control but also for less in the way of disfiguring and distres sing complications associated with the treatment programs. In 1988, the American Cancer Society estimates that there will be 42400 new cases of malignant tumors of the head and neck diagnosed with 12 850 deaths. In general, the prognosis for patients with malignant tumors of the head and neck re gion depends upon the site of origin, the local and regional extent of the tumor, the Kar nofsky status of the patient as well as the patient's general medical condition. The poten tial for cure for early stage tumors is extremely high particularly for those lesions involving the vocal cord, oral cavity, and the anterior two-thirds of the tongue. Major advances have been made in the management of head and neck cancer by the innovative utilization of surgery with radiation therapy. Small tumors can be cured by ei ther surgery or radiation therapy with equally good results. However, far advanced tu mors are more complicated and more difficult to cure requiring combined, integrated, multimodal programs of management. Therefore, the previously general poor prognosis for advanced tumors is becoming better with more aggressive treatment regimens.

This issue of Radiation Medicine Rounds examines the latest advances in the use of radiation medicine in treatment of head and neck cancer. Head and neck cancer treatment has undergone major change over the course of the past few years and Head and Neck Cancer addresses current best practices in the light of the most recent evidence. Head and Neck Cancer addresses a wide range of topics under the broad heading of head and neck oncology. In the initial section, the authors address therapeutic approaches with chapters on current and future treatments. Coverage is extensive and includes articles on IMRT, combined modality treatments, the use of targeted agents in conjunction with chemotherapy, the use of transoral robotic surgery followed by postoperative radiation therapy, and the use of particle therapy. The second section addresses issues of health services and covers palliative care, how to assess toxicity in patients, and issues of interpreting and integrating classic study data into treatment decisions. The third section examines the factors influencing clinical decisions ranging including biomarkers and image guidance. . Radiation Medicine Rounds features : In-depth, up-to-date expert reviews and analysis of major new developments in all areas of Radiation Medicine Each issue edited by an authority in that subject area Each issue focused on a single major topic in Radiation Medicine, providing coverage of advances in radiation science, radiation medicine technology, radiation medicine practice, and assessment of recent quality and outcome studies Series Description: Radiation Medicine Rounds is a review series providing a thorough analysis of new scientific, technologic, and clinical advances in all areas of radiation medicine. There will be an emphasis throughout on multidisciplinary approaches to the specialty, as well as an emphasis on quality and outcomes analysis. The goal is to provide authoritative, thorough assessment of a wide range of "hot topics" and emerging new data for the entire specialty of radiation medicine.

Developments in radiation oncology have been key to the tremendous progress made in the field in recent years. The combination of optimal systemic treatment and local therapy has resulted in continuing improved outcomes of cancer therapy. This progress forms the basis for current pre-clinical and clinical research which will strengthen the position of radiation oncology as an essential component of oncological care. This book summarizes recent advances in radiotherapy research and clinical patient care. Topics include radiobiology, radiotherapy technology, and particle therapy. Chapters cover a summary and analysis of recent developments in the search for biomarkers for precision radiotherapy, novel imaging possibilities and treatment planning, and advances in understanding the differences between photon and particle radiotherapy. Advances in Radiation Therapy is an invaluable source of information for scientists and clinicians working in the field of radiation oncology. It is also a relevant resource for those interested in the broad topic of radiotherapy in general.

The contemporary management of patients with cancers of the head and neck is under careful scrutiny and major changes are being introduced in order to improve the potenti al not only for long-term control but also for less in the way of disfiguring and distres sing complications associated with the treatment programs. In 1988, the American Cancer Society estimates that there will be 42400 new cases of malignant tumors of the head and neck diagnosed with 12 850 deaths. In general, the prognosis for patients with malignant tumors of the head and neck re gion depends upon the site of origin, the local and regional extent of the tumor, the Kar nofsky status of the patient as well as the patient's general medical condition. The poten tial for cure for early stage tumors is extremely high particularly for those lesions involving the vocal cord, oral cavity, and the anterior two-thirds of the tongue. Major advances have been made in the management of head and neck cancer by the innovative utilization of surgery with radiation therapy. Small tumors can be cured by ei ther surgery or radiation therapy with equally good results. However, far advanced tu mors are more complicated and more difficult to cure requiring combined, integrated, multimodal programs of management. Therefore, the previously general poor prognosis for advanced tumors is becoming better with more aggressive treatment regimens.