Radiation therapy for nonsquamous tumors of the head and neck

Recent advances in the understanding of the natural history and modes of spread of the nonsquamous malignancies of the head and neck region have delineated an important role for radiotherapy in their management. The indications for primary radiotherapy include malignant lymphoma of the thyroid, idiopathic midline granuloma, midline malignant reticulosis, extramedullary plasmacytomas, esthesioneuroblastomas, and locally aggressive benign tumors, such as glomus tumors, angiofibromas, and hemangiomas. Although the traditional treatment for malignant melanoma is surgery, indications are emerging for high-dose radiotherapy, either as the only modality or in addition to surgery. Combined radiotherapy and chemotherapy is the treatment choice for nonHodgkin's lymphomas of the Waldeyer's ring and for Ewing's sarcomas. High-grade soft tissue sarcomas and salivary gland malignancies are best treated with surgery and postoperative radiotherapy. The use of megavoltage photons and electrons, custom-made blocks delineating the treatment volume, tissue compensators, patient immobilization devices, and simulator-aided treatment planning are mandatory to achieve loco-regional control and to minimize the treatment-related morbidity.