Abstract
Radiotherapy has an important role for the treatment of head and neck cancer (HNC) due to functional preservation compared with surgery. Although radiotherapy is the most curative treatment for unresectable HNC, the results of radiotherapy alone are poor. In recent years a number of trials have been performed such as hyperfractionated radiotherapy and chemoradiotherapy, and meta-analysis has demonstrated an absolute improvement in survival with concurrent chemoradiotherapy over radiotherapy alone. Nowadays concurrent chemoradiotherapy has become a standard treatment for unresectable HNC.
Recently many kinds of molecular targeted drugs have been investigated. Cetuximab plus radiotherapy has been shown to improve survival. However, the relative efficacy of radiotherapy with cetuximab compared with concurrent chemoradiotherapy for patients with HNC is still unclear.
To improve survival and reduce treatment-related toxicity, new treatment modalities such as intensity modulated radiotherapy (IMRT) and particle therapy have been developed. Although IMRT is able to reduce the risk of xerostomia, it is not clear whether IMRT improves survival of unresectable HNC. On the other hand, particle therapy has been reported to have efficacy in treating radio-resistant tumors. The treatment results of unresectable HNC have not been satisfactory. Multidisciplinary therapies such as chemoradiotherapy combined with intra-arterial chemotherapy and/or molecular targeted drugs play important roles in improving prognosis.
