Radiotherapy for head and neck cancers including chemoradiotherapy

After two decades of clinical investigations on hyperfractionation, a 10% local control gain at 5 years was finally demonstrated by a large, randomized trial in oropharyngeal carcinoma, which confirms promising data from numerous uncontrolled studies. Moreover, this progress was achieved without additional late morbidity, in agreement with radiobiology predictions of the linear quadratic model. Data from in vivo measures of the survival fraction after 2 Gy and potential doubling time show a trend for a poorer prognosis in rapidly proliferating tumors, however, unequivocal evidence does not yet exist. Retrospective studies document the detrimental effect of prolonged overall treatment time and support investigations on accelerated radiotherapy as a priority. Reports on the combination of chemotherapy and radiotherapy (mostly concomitantly) still leave the reader with a feeling of frustration. All reports, except one, have a poor methodology without a control arm to use the best-known regimens of radiotherapy and surgery. Nasopharyngeal tumors should not be mixed up with other head and neck sites because impressive responses can follow adequate combination strategies of chemoradiotherapy. Xerostomia is no longer an unavoidable and hopeless side-effect of radiotherapy; individualized treatment planning and stimulation of remaining salivary glands by pilocarpine can improve the comfort in about 50% of irradiated patients.