Progress in radiotherapy by treatment tailoring in head and neck cancer

Radiotherapy plays a key role with surgery in the treatment of head and neck cancer. Encouraging results have recently been published indicating new ways to improve locoregional control by tailoring the radiation treatment to individual tumors. This has been reached by the following means: adapting fractionation schemes to the potential doubling time of tumors, technical developments resulting in higher doses to the primary tumor and at the same time reducing normal tissue doses, and the concomitant use of radiotherapy and chemotherapy. Fractionation studies have shown that changing the standard fractionation schedule can increase the therapeutic margin of radiotherapy. Predictive assays are now becoming available to provide guidelines for the optimal fractionation schedules in individual patients. Combined treatment with radiotherapy and chemotherapy has been widely tested and although the results have been generally disappointing, one approach remains promising, ie, the concomitant use of these two modalities, which seems to result in a modest improvement of survival. Increasing the radiation dose to the tumor together with a better shielding of normal tissues has become possible by technical developments in radiotherapy such as three-dimensional treatment planning, multileaf collimators, and quality control procedures using megavoltage imaging devices.