Radiotherapy for cancer of the head and neck

Achievements in radiotherapy of head and neck cancer continue. During the past decade, bench marks have been established for certain early staged malignancies. Technical advances have occurred in higher energy accelerators with the development of dual photon and medium-range electron machines. Imaging technology has augmented precision tumor localization and staging, and its marriage to computerized treatment planning is leading the way toward an optimization of delivered radiation dose to the tumor volume. Neutron therapy is finding a definite place in moderately advanced head and neck cancers, and its wider use awaits further developments in compact neutron generators. Hyperthermia combined with photon radiation is undergoing serious clinical trials, and this combination appears to be most promising. The search for radiation sensitizers to enhance tumor destruction and for radioprotectors for normal tissue continues. Progress in the latter appears encouraging. Burgeoning radiobiologic data have led the way to several dose fractionation schemes, and the most promising clinically appears to be hyperfractionation. Combinations of surgery and radiotherapy have improved cure rates in moderately advanced malignancies, but a preference between preoperative and postoperative radiotherapy in specific sites is still controversial. The medical oncologist has become a valued member of the interdisciplinary team rather than remaining solely the recipient of failed radiotherapeutic and surgical patients. There is a keener awareness of the difficulties and intricacies involved in the construction and evaluation of clinical trials and results.