When is radiation therapy in head and neck squamous cell carcinoma not indicated?

Abstract

Head and neck squamous cell carcinoma (HNSCC) can be treated with surgery, radiotherapy (RT), and/or chemotherapy depending on the location and extent of the neoplasm. Treatment selection also depends on the goal of therapy (curative or palliative) and the expected efficacy weighed against the expected morbidity of the treatment. Moreover, it may be determined by the treatment modalities available, although all modalities will usually be available in most centers in developed countries. Earlystage HNSCCs can usually be treated with a single modality, whereas advanced-stage disease requires multimodality treatment. The choice of treatment modality will depend on factors including tumor site, existing and expected functionality, cosmetic outcome, age, performance status, the likelihood that adjuvant postoperative RT will be required, and the wishes of the patient. Following is a discussion of the curative-intent management of patients with mucosal HNSCC and situations where RT can be safely eliminated. Surgery alone is the preferred treatment for patients with HNSCC when the probability of a complete resection is high ([85–90 %) and the functional and cosmetic outcome is acceptable. An important caveat is that a functional/ cosmetic outcome that is acceptable to the physician may or may not be acceptable to the patient. Other factors such as patient age and medical co-morbidities also influence the decision. Patients with human papilloma virus (HPV)positive oropharyngeal squamous cell carcinomas (SCCs) have a better prognosis than those with HPV-negative SCCs. It could be reasoned that these patients should be treated differently. Depending on extent of disease, surgery alone, transoral robotic surgery (TORS) in particular, could be an attractive option as this group of patients is usually of younger age. However, the question if and how patients should be treated differently depending on HPV status is the subject of trials now and no firm recommendation can be made at this point [1, 2]. Although the adverse impacts The paper was written by members of the International Head and Neck Scientific Group (www.IHNSG.com).