Primary and adjuvant radio(chemo) therapy of head and neck cancer. Indications, techniques, results

BackgroundPercutaneous definitive or adjuvant radiotherapy or radio(chemo)therapy is one of the curative treatment options for squamous cell carcinoma of the head and neck region (HNSCC).ObjectiveThis article gives an overview of current treatment approaches and results of radio(chemo)therapy in the context of definitive and postoperative treatment.Material and methodsA review of current guidelines and a literature search via the PubMed database were carried out.ResultsThe HNSCC is treated in astage-adapted manner. Early stages (cT1-2, cN0-1) are treated with radiotherapy alone (RT) and locally advanced stages with radiochemotherapy (RCT). Intensity-modulated RT (IMRT) results in comparable results with fewer side effects. Particle therapy can have advantages. The definitive RCT represents the gold standard. Adjuvant RT is indicated in cases of pT3, pN + and adjuvant RCT for high-risk features such as positive resection margins or extranodal spread (ENE). The HPV positive oropharyngeal carcinomas have the most favorable prognosis. Clinical trials for de-intensification and combination with checkpoint inhibitors are currently recruiting.ConclusionModern percutaneous radiotherapy is an integral part of treatment, can reduce side effects and is used in astage-dependent manner alone or in combination with systemic treatment and/or surgery. The treatment for HPV-associated and HPV negative HNSCC is identical. The gold standard for locally advanced stages is simultaneous radiochemotherapy with cisplatin.