Radiation Oncology - Head and Neck Cancers

Dear Colleagues,

Head and neck cancers represent a heterogeneous group of tumors with different epidemiology, etiology, and therapeutic management. The majority are squamous cell carcinomas (HNSCC) that originate in the oral cavity, oropharynx, nasopharynx, larynx or skin. Achieving local disease control in patients with HNSCC is critical. In the absence of local control, early mortality from HNSCC is certain, and tumor progression can result in debilitating symptoms. Radiation therapy plays a vital role in the local management of HNSCC and can be given as a curative treatment or to palliate tumor-related symptoms in patients with incurable disease. Curative treatment with radiation can be either definitive, where radiation is the principle modality, or adjuvant, to reduce the incidence of recurrence from surgery.

Head and neck radiation therapy is a clinical challenge due to the complex anatomy, tumor heterogeneity, and increased risk of severe treatment complications. Modern advances such as image-guided radiation therapy (IGRT), intensity-modulated radiation therapy (IMRT), particle therapy, and stereotactic radiation therapy (SRT) offer a renewed opportunity to widen the therapeutic window by maximizing tumor control probability and minimizing normal tissue complication risk. IGRT coupled with IMRT or particle therapy enable precise and conformal dose delivery using smaller treatment margins and steep dose gradients outside the target to improve normal tissue sparing and treatment toxicity. The emergence of ablative dose SRT has challenged the long-standing dogma of fractionation, resulting in shorter treatment courses, increased patient convenience, and lower health care cost. Radiation therapy is an image-guided intervention. In addition to altered fractionation strategies, advances in functional and metabolic imaging have improved disease evaluation, tumor delineation, and treatment planning. Finally, the use of molecular targeted biological and immunotherapeutic systemic agents combined with radiotherapy highlights new strategies to overcome treatment resistance. Future strategies include development of predictive genomic, expression or immunohistochemical markers to deliver a more hypothesis-driven and personalized treatment tailored to the patient and tumor.

There is little doubt that the pace of progress will increase in the coming years. As the field of radiation oncology advances, it is important to keep in mind the best management approach for patients with HNSCC is still interdisciplinary treatment planning. Before initiating treatment, the multidisciplinary team of head and neck surgeons, medical oncologists and speech, dental, and audiology experts should plan the anticipated extent, sequence, and modality of therapy. The aim of this issue is to highlight the unique role of radiotherapy and its recent advances in the management of HNC. This Special Issue welcomes submissions of original clinical research articles, case reports, and high-quality reviews on established and/or novel strategies that address these and related topics.

Assoc. Prof. Dr. Jack Phan
Guest Editor

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• radiation oncology
• head and neck cancers
• radiation therapy
• HNSCC
• image-guided radiation therapy
• intensity-modulated radiation therapy
• particle therapy
• stereotactic radiation therapy