An Updated Review on Head and Neck Cancer Treatment with Radiation Therapy

SIMPLE SUMMARY: The mainstay of treatment for locoregionally advanced head and neck squamous cell carcinoma (HNSCC) is either surgery followed by adjuvant radiation therapy or definitive concurrent chemoradiation (CRT) reserving surgery as salvage therapy, referred to as the organ-preservation approach. Head and neck cancer treatment requires a multidisciplinary approach with medical, surgical, and radiation oncology, pathology, radiology, and supportive services including physical and occupational therapy, speech and swallow therapy, and nutrition. The field has rapidly evolved with rising rates of HPV positive oropharyngeal cancers leading to treatment de-escalation studies that are currently ongoing. Additionally, multiple trials are ongoing to evaluate the role of novel agents including immune checkpoint inhibitors, less invasive surgical approaches, and radiation field and dose reductions in order to maintain effective tumor control while improving quality of life outcomes for our head and neck cancer patients. ABSTRACT: The complexity of head and neck cancers (HNC) mandates a multidisciplinary approach and radiation therapy (RT) plays a critical role in the optimal management of patients with HNC, either as frontline or adjuvant treatment postoperatively. The advent of both definitive and post-operative RT has significantly improved the outcomes of patients with HNC. Herein, we discuss the role of postoperative RT in different subtypes of HNC, its side effects, and the importance of surveillance. The treatment regions discussed in this paper are the oral cavity, nasopharynx, paranasal sinus cavity, oropharynx, larynx and hypopharynx. Multiple studies that demonstrate the importance of definitive and/or postoperative RT, which led to an improved outlook of survival for HNC patients will be discussed.