Novel technological aspects of radiation therapy in head and neck cancer

Abstract

Radiation therapy (RT) is an important treatment modality in head and neck cancer (HNC) irrespective of stage, histology, and location of the primary tumor in both curative and palliative setting, with or without other treatment modalities such as surgery or chemotherapy. Based on advances with better imaging and introduction of sophisticated software for treatment and planning systems, radiation oncology of HNC witnessed major advantages resulting in both improved local control and better sparing of organs at risk. From computed tomography to magnetic resonance imaging and introduction of positron emission tomography with various radiotracers it became possible not only to diagnose and stage HNC with more confidence but also to introduce these technologies in RT treatment planning, and to use it during the RT course for the evaluation of response and additionally sculpture RT fields. Furthermore, it became possible to predict outcome based on anatomic and metabolic changes in HNC. Community of radiation oncologists successfully adopted transition from two-dimensional to three-di-mensional RT and then to intensity modulated RT, as well as stereotactic radiotherapy (either single-or multi-fraction) regimens. There is renewed interest in heavy particles with both neutrons, carbon-ions and protons, the latter two being used more frequently in the recent years. This review article summa-rizes the most important accepts of novel RT technologies in HNC.