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Definitive radiation therapy alone for advanced (stage III and IV) head and neck cancer: Dose and fractionation schedule

Shlomo A Koyfman, MD
Wendy Hara, MD
Section Editors
Bruce E Brockstein, MD
David M Brizel, MD
Marshall R Posner, MD
Deputy Editor
Michael E Ross, MD


Patients with locoregionally advanced, stage III or IV, head and neck squamous cell carcinoma are usually managed with a combined modality approach that includes surgery, radiation therapy (RT), and/or chemotherapy. Traditionally, these tumors were managed with a combination of surgery and RT, if operable. In the last several decades, definitive RT plus chemotherapy is being used for patients where organ function preservation is appropriate, for those with surgically unresectable disease, and for those who are medically inoperable.

Issues regarding the optimal dose and schedule for patients receiving definitive RT are reviewed here. The principles of RT as applied to patients with head and neck cancer are presented separately. (See "General principles of radiation therapy for head and neck cancer".)


Definitive RT alone remains an appropriate option for selected patients with stage III/IV disease. These include:

Patients with a contraindication to platinum-based chemotherapy (eg, hearing loss, renal insufficiency, neuropathy, bone marrow disease). The use of RT plus cetuximab in this setting is discussed elsewhere. (See "Locally advanced squamous cell carcinoma of the head and neck: Approaches combining chemotherapy and radiation therapy", section on 'Cetuximab alone plus RT'.)

Patients who refuse chemotherapy but still desire the locoregional control and possible survival benefits of RT.


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Literature review current through: Apr 2017. | This topic last updated: May 09, 2016.
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