In regard to Lee et al. intensity-modulated radiation therapy for head-and-neck cancer: the UCSF experience focusing on target volume delineation. (int j radiat oncol biol phys 2003;57:49?60)

Abstract

The conclusion by Lee et al. ( 1 Lee N. Xia P. Fischbein N.J. et al. Intensity-modulated radiation therapy for head-and-neck cancer: The UCSF experience focusing on target volume delineation. Int J Radiat Oncol Biol Phys. 2003; 57: 49-60 Abstract Full Text Full Text PDF PubMed Scopus (245) Google Scholar ) that “accurate target volume delineation in intensity modulated radiotherapy (IMRT) treatment for head-and-neck cancer is essential” is no doubt correct, as is their described multidisciplinary approach in target volume definition. In fact, accurate target volume delineation with a multidisciplinary approach is the foundation to all radiation treatments, regardless of techniques used or cancer location. However, for this report, their patient selection may provide misleading information regarding IMRT treatment in head-and-neck cancer. Although the authors recognized this in the discussion, the importance cannot be overstated. Of the 150 patients treated, 86 (57%) had nasopharyngeal cancer, 24 (16%) had paranasal sinus/nasal cavity cancer, and 12 (8%) had miscellaneous cancer, including thyroid and salivary gland malignancy. These cancers behave differently and, in general, are separately discussed from “head-and-neck cancer” in most publications. Therefore, it is inappropriate to discuss the treatment outcomes for this selected group of patients, thereby indicating IMRT treatment can provide both excellent local control and overall survival for general head-and-neck cancer. It is also inappropriate to imply postoperative radiation has a higher failure rate without further subsite comparison.