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Definitive radiation therapy for head and neck cancer: Dose and fractionation considerations

Authors
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

INTRODUCTION

Patients with head and neck squamous cell carcinoma arising at certain sites (eg, larynx, oropharynx) can often be managed with surgical resection or with radiation therapy (RT) with or without chemotherapy, whereas other sites (eg, oral cavity, paranasal sinus) are traditionally treated surgically with or without adjuvant RT. Other treatment sites (nasopharyngeal cancer) are typically treated with a nonsurgical radiation-based approach. For patients with early 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 a nonsurgical, organ-preserving alternative to 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, single-modality definitive RT is also an appropriate option for selected patients. These include:

                   
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Literature review current through: Sep 2017. | This topic last updated: Sep 19, 2017.
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