Definitive radiation therapy for head and neck cancer: Dose and fractionation considerations
- Shlomo A Koyfman, MD
Shlomo A Koyfman, MD
- Assistant Professor of Medicine
- Departments of Radiation Oncology and Bioethics
- Cleveland Clinic
- Wendy Hara, MD
Wendy Hara, MD
- Clinical Assistant Professor, Department of Radiation Oncology
- Stanford University
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marshall R Posner, MD
Marshall R Posner, MD
- Section Editor — Cancer of the Head and Neck
- Professor of Gene and Cell Medicine
- The Tisch Cancer Institute
- Icahn School of Medicine at Mount Sinai
Patients with head and neck squamous cell carcinoma can often be managed with surgical resection or with radiation therapy (RT) with or without chemotherapy. In earlier-stage disease (T1-2N0), radiation monotherapy is a standard alternative to surgery as a curative modality. In the locally advanced setting (T3-4, N+), intensified RT or concurrent chemoradiotherapy is frequently used as an organ-preserving alternative to surgical resection.
In both earlier and more-advanced stages of disease, there are unique considerations regarding optimal radiation dosing, fractionation schedules, and timing of therapy for patients managed nonoperatively with definitive RT. These issues 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".)
PATIENT SELECTION FOR DEFINITIVE RADIATION
Definitive radiation therapy (RT) alone remains a standard option for patients with stage I to II disease. A detailed presentation of selecting operative versus nonoperative therapy for early stage head and neck cancer is discussed elsewhere. (See "Treatment of early (stage I and II) head and neck cancer: The larynx" and "Treatment of early (stage I and II) head and neck cancer: The hypopharynx".)
In the locally advanced (stage III/IV) setting, definitive RT is also an appropriate option for selected patients. These include:
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- PATIENT SELECTION FOR DEFINITIVE RADIATION
- PARADIGMS OF DOSE AND FRACTIONATION MODIFICATION
- Early versus advanced stage disease
- Clinical trial results
- Clinical trial results
- - RTOG 9003
- - MARCH meta-analysis
- Optimal hyperfractionation: Dose and schedule
- Concurrent chemoradiotherapy using hyperfractionated RT
- ACCELERATED FRACTIONATION RT
- Clinical trial results
- Concurrent chemoradiotherapy using accelerated RT
- TOXICITY OF HYPERFRACTIONATED AND ACCELERATED RT
- COST AND CONVENIENCE
- SIMULTANEOUS INTEGRATED BOOST TECHNIQUE WITH IMRT
- MANAGEMENT OF THE NECK AFTER RT
- SUMMARY AND RECOMMENDATIONS