Carbon Ion Radiotherapy in the Head and Neck Cancers Treatment and its Potential Role in Personalized Treatment Approach- A Review of the Current Knowledge.

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Head and neck cancer (HNC) is a complex, heterogeneous group of malignancies. In treatment a combined modality therapy with surgery, radiotherapy and chemotherapy is usually advised. The use of charged particles was a breakthrough in radiation oncology and allowed the initiation of cancer treatment with high-precision. The purpose of the work is to discuss the role of carbon ion radiotherapy in the treatment of head and neck cancers. Heavy ions such as carbon have more favorable physical and radiobiological properties than photons. The unique properties of carbon ions enable radiotherapy with dose escalation to tumors, while reducing both, radiation dose to adjacent normal tissues and radiation area. Considering its exceptional features, carbon ion radiotherapy offers promising results with acceptable toxicity regarding treatment of uncommon and rare malignancies, especially treated for a recurrent disease. HNC patients with adenoid cystic carcinoma and mucosal melanoma of the head and neck, which are considered to be radiation resistant, should benefit more from carbon ion radiotherapy than proton beam therapy or conventional photon radiotherapy. Also selected patients with other head and neck malignancies can benefit form carbon ion radiotherapy including advanced salivary gland cancer and nasopharyngeal cancer patients. Carbon ion radiotherapy offers better dose distributions, higher tumor doses, and an increased odds of local control and prolonged survival. Carbon ion radiotherapy represents a promising alternative to conventional photon RT or even proton beam therapy especially in treatment of radioresistant tumors situated close to critical organs.