Review of Postoperative and Elective Nodal Irradiation in Head and Neck Cancer

Abstract

Abstract: Radiotherapy plays a critical role in the nodal management of patients with head and neck cancer. The indications, dose fractionation schedules, and results of postoperative radiation therapy (PORT) and elec-tive nodal management (ENI) in various head and neck cancers are reviewed and summarized with common themes identified. Keywords: Elective irradiation, head and neck cancer, lymph nodes, postoperative irradiation, skin cancer. INTRODUCTION Cancers in the head and neck region commonly spread to regional cervical, retropharyngeal and parotid lymph nodes in a predictable pattern. Man-agement of nodal disease is dependent on primary tumor histology and location, extent of primary and nodal disease, surgical resectability of nodal disease and medical operability of the patient. In patients treated with upfront surgical resection of nodal disease, PORT is commonly utilized to re-duce the risk of regional recurrence. Elective nodal irradiation of draining nodal stations has been shown to reduce regional recurrence as well. For example, in mucosal squamous cell carcinomas of the head and neck large prospective, randomized trials have been conducted to define the role for postoperative nodal irradiation and chemotherapy [1,2] and data has existed supporting ENI for at least forty years [3]. The National Comprehensive Cancer Network (NCCN) provides updated con-sensus guidelines for PORT and ENI for common cancers of the head and neck region and these guidelines are a valuable resource for clinicians that provide a national standard for radiation treatment [4-7].