Radiation Therapy for Head and Neck Cancers by Murat Beyzadeoglu Gokhan Ozyigit & Ugur Selek

Author:Murat Beyzadeoglu, Gokhan Ozyigit & Ugur Selek
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

2 Evidence-Based Treatment Approaches

Single modality radiotherapy or primary surgery (transoral or open resection) for stage T1-2 N0-1 has been preferred with similar rates of local control and survival, as no prospective randomized comparison is present [1–3]. Concurrent chemoradiotherapy is mostly the key treatment for locally advanced stages III and IVA/B cancers without distant metastases (Table 7.1) [4–11], while the resectability and neck nodal disease volume are denominators in decision making to perform initially surgery for primary (T3–T4a) and neck (N0-1) and to consolidate with radiotherapy (close resection margins, lymphovascular and perineural invasion , pT3-T4, N2 or N3, nodal disease levels IV–V) or chemoradiotherapy (positive surgical margins and/or nodal extracapsular invasion) metastases (Table 7.2) [12–15]. Induction chemotherapy followed by radio/chemoradiotherapy is yet a category three approach which might be considered in heavy nodal volume with an increased risk of distant metastases [5, 6, 16–19]. Cetuximab as a single agent concurrent with radiotherapy for treatment of locoregionally advanced head and neck cancer seemed to improve locoregional control and to reduce mortality, while the addition of cetuximab to the chemoradiotherapy with cisplatin did not improve progression-free or overall survival [20].Table 7.1Large, randomized phase III trials of concurrent chemoradiation

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