A Rational Approach to Unilateral Neck RT for Head and Neck Cancers in the Era of Immunotherapy

SIMPLE SUMMARY: Elective radiation of clinically uninvolved lymph nodes for head and neck cancer should balance the risk of treating occult metastatic disease and maintaining patient quality of life. Clinical trials exploring combining radiation with immunotherapy have thus far been disappointing. This review proposes limiting elective neck radiation to reduce iatrogenic immunosuppression in future trials of immunoradiation. ABSTRACT: Radiotherapy plays an important role in the definitive and adjuvant treatment of head and neck squamous cell carcinoma (HNSCC). However, standard courses of radiation therapy may contribute to the depletion of circulating lymphocytes and potentially attenuate optimal tumor antigen presentation that may be detrimental to the efficacy of novel immunotherapeutic agents. This review explores the advantages of restricting radiation to the primary tumor/tumor bed and ipsilateral elective neck as it pertains to the evolving field of immunotherapy.