Technologic Advances in External Beam Radiotherapy for Head and Neck Cancer

Abstract

Purpose:Radiotherapy (RT) has evolved substantially since its first clinical use in 1896. Most recently, the introduction of the computed tomography (CT) scan in the 1980s launched 2 decades of technologic (r)evolution. In this article we will give an overview of the recent technical advances in external beam RT for head and neck cancer (HNC).Discussion:In HNC, intensity-modulated RT (IMRT) has become standard of care as it has shown superiority over 3D conformal RT in terms of prevention of xerostomia. Other treatment options are fractionated stereotactic RT as a boost and the use of particle therapy with its interesting ballistic capacities. Carbon ions will be mainly used for radio-resistant cancers because of the supplementary higher biologic effect. Adaptive RT is promising but needs much more evolution before it can be optimally used. All these new techniques require a high level of image guidance in order to reach their maximal capacities. Rigorous quality assurance of all the different steps in the irradiation process is essential to deliver the right dose exactly at the right place.Conclusion:The recent rapid technologic evolution in RT is particularly interesting for HNC as it permits better sparing of the many radiosensitive organs in close vicinity to these aggressive tumors.