Selected topics in head and neck cancer

Using four short vignettes, the author discusses different aspects of radiotherapy for head and neck cancer. The most widely used modality for this disease, radiotherapy can be used for early-stage cancer as the definitive treatment, as part of organ preservation for intermediate to moderately advanced stage cancer, and as radical or palliative therapy for locally advanced cancer. The article includes a brief summary of three major randomized trials of radiotherapy alone versus chemoradiotherapy in the adjuvant postoperative setting for high-risk head and neck cancer, practical information on the indications for adjuvant therapy after surgery, commonly used peer-reviewed radiotherapy fractionation schedules for definitive (nonoperative) treatment, a comparison of radiotherapy alone versus radiotherapy plus weekly cetuximab, and a list of eligibility requirements to consider re-irradiation. The author concludes with a look ahead at the new biologic therapies now available.