Modern Radiotherapy for Head and Neck Cancers: Benefits and Pitfalls - a Literature Review

Abstract

Curative radiotherapy is part of the multimodal treatment for locally advanced head and neck cancers. The technical revolution in the fi eld of radiation therapy and medical imaging has made possible a better conformation of the target volumes with irregular shapes with a dose reduction at the radiosensitive organs in the vicinity. Three-dimensional Conformal Radiotherapy (3D-CRT) has been replaced by Intensity Modulated Radiotherapy (IMRT), and more recently the Intensity Modulated Volumetric Arc Therapy (VMAT) technique is being used on an ever-expanding scale as a replacement for the "step and shot" IMRT technique. The benefi ts of the IMRT/VMAT techniques were mainly consisting of a better conformation for the target volumes with irregular shapes and the reduction of acute and late xerostomia. The results in the tumor control are considered similar to those obtained by the 3D-CRT technique except for nasopharyngeal cancer in which the use of chemo-radiotherapy by the IMRT technique has led to an improved local survival and local and regional control rate. Increasing the incidence of HPV-positive head and neck cancers with a better prognosis and the need to improve quality of life would be an argument in favor of using treatments with a low toxicity profi le. By reducing the dose of healthy tissue, the use of modern irradiation techniques opens new horizons for the re-irradiation with high radiation doses of recurrent head and neck tumors.