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Radiation Therapy in Head and Neck Cancers

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Radiation Therapy in Head and Neck Cancers

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Radiation therapy is an integral and influential part of head and neck cancer treatment. This article provides insights into the role of radiotherapy in head and neck cancers.

Medically reviewed by

Dr. Sneha Kannan

Published At May 13, 2019
Reviewed AtAugust 3, 2023

Introduction

Cancers of the head and neck region are a heterogeneous group of tumors affecting different areas such as the oral cavity, pharynx (nasopharynx, oropharynx, and hypopharynx), larynx, paranasal sinuses, nasal cavity, thyroid gland, etc. Each of these tumors behaves differently with a varied prognosis requiring a multidisciplinary approach (team of surgical, radiation and medical oncologists) for optimal management.

Local management options include surgery and radiation therapy, used either alone or latter as an adjuvant modality. In the adjuvant setting, the goal of radiation therapy is to prevent local recurrence. Role of radiation therapy has increased tremendously in the past decade, with nearly 60 percent of head and neck cancers requiring radiation therapy. The basic principle of radiation therapy is the maximum dose to the tumor and minimum to the nearby healthy organs. This has been made possible with advances in technology.

Depending on the stage of cancer, different management options are available. Factors which help in decision making can be categorized as patient related (age, associated co-morbidities, performance status, finances), disease-related (site, histology, stage), and treatment-related (cost, side effects). Early stage disease can be managed using a single modality either surgery or radiation therapy. Locally advanced cases especially of the oral cavity, are usually treated with surgery followed by radiation therapy, where surgery removes the gross tumor and radiation therapy further sterilizes the tumor bed, thus minimizing the chances of recurrence. Further evidence has taught us that giving chemotherapy along with radiation therapy in select cases amplifies the effect of radiation, thus enhancing the chances of tumor control.

What Are the Indications for Radiation Therapy and Chemotherapy?

The general indications of radiation therapy in the postoperative setting are guided by principles of increased probability of local recurrence. These indications are:

  • Large tumor size (> 2 cm).
  • Positive surgical margin.
  • High-grade lymphovascular and perineural invasion.
  • Nodal involvement.

Concurrent chemotherapy is indicated in a positive margin and extranodal extension. Each of these factors is associated with poor prognosis and requires aggressive combined modality approach.

Sites, where radiation with concurrent chemotherapy forms the definitive treatment and results are equivalent to surgery, are nasopharynx, oropharynx, hypopharynx, and larynx. The advantage of chemoradiation over surgery in these sites is function preservation. Other factors that may influence radiation over surgery are patient choice and morbidity associated with surgery higher than that associated with radiation.

Importance of Treating Nodal Involvement:

Another crucial aspect in the management of head and neck cancers that requires mentioning is the treatment of the nodes. Primary drainage nodes should always be the treatment, and proper knowledge of nodal drainage according to the site is very important. Recent studies have shown the importance of treating nodes prophylactically since survival is inversely related to nodal involvement.

Radiation-related side effects can be acute and/or delayed. Factors influencing these side effects can be categorized as patient related (age, associated co-morbidities, performance status), and treatment-related (radiation volume, dose to normal organs, the technique of radiation used, and concurrent chemotherapy). Acute complications are:

  • Loss or impairment of the sense of taste.
  • Mucositis of the oral cavity and pharynx.
  • Decreased saliva secretion.
  • Darkening of the skin.

Complications experienced after six months:

What Are the Modern Advancement in Radiotherapy?

Modern radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT), can offer precise radiation delivery and reduce the dose to the surrounding normal tissues without compromising the target.

  1. IMRT is an advanced form of three-dimensional conformal radiotherapy using computer-optimized inverse treatment planning and a computer-controlled multi-leaf collimator.
  2. IGRT is a revolutionary technique that employs the use of imaging (X-ray or CT scan) to ensure accurate radiation delivery as planning.

With these techniques, the intensity of radiation can be modulated so that a higher radiation dose can be delivered to the targets with a sharply conformal target volume coverage, while at the same time the dose to the surrounding normal tissues is markedly reduced. To give the best results, IGRT is usually combined with IMRT.

In addition to IMRT and IGRT, there are certain other novel radiotherapy techniques. Some of them includes:

  • Stereotactic body radiotherapy (advanced form of IGRT).
  • Brachytherapy (radiation emitting material placed into the body in the form of capsule or seed).
  • Proton therapy (restrict cellular damage within the tumor area).

Conclusion

Head and neck cancers are one of the top three cancers worldwide. Radiation therapy has proved itself to be a valuable component of the management of these cancers, either as an adjunct to surgery, or alone depending upon various factors. There are multiple studies and trials in literature which has proven the equivalence of radiation therapy to surgery with lesser side effects. The invent of various advancement in radiotherapy field is offering promising results for various head and neck cancers.

Frequently Asked Questions

1.

Is Radiation Therapy Effective for Head and Neck Cancer?

The special effectiveness of radiation treatment in treating head and neck malignancies is well documented. A significantly lower radiation dose can be used to treat HPV-related head and neck cancer to minimize negative effects. Radiation therapy is one of the many ways to treat head and neck cancer.

2.

For How Long Radiation Treatment Is Given for Head and Neck Cancer?

For around weeks, patients will receive radiation treatments daily. On the same day, patients can receive radiation and chemotherapy. Chemotherapy can be administered either before or after radiation therapy without risk.

3.

What Is the Best Treatment for Head and Neck Cancer?

Surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy are the primary forms of treatment. A treatment plan consists of surgery, radiation therapy, or combination of both.

4.

Can Fourth Stage of Head and Neck Cancer Be Cured?

Patients suffering from metastatic or recurrent head and neck squamous cell carcinoma usually have a poor prognosis. Depending on patient and disease-related characteristics, the median survival in most series ranges from up to 15 months. Care that is symptom-focused is crucial in the management of these patients.

5.

How Long Do Head and Neck Radiation Side Effects Last?

About two weeks after beginning medication, patients can experience adverse effects. They might get worse while receiving therapy, but they will gradually improve over the course of six to eight weeks once patients have finished. It could take longer for some adverse effects to fade away.

6.

Is Head and Neck Radiation Painful?

Radiation-induced pain worsens as it progresses, lingers after treatment, and continues for 12 months in some individuals. In addition to oral rinses, systemic analgesics are frequently needed for pain.

7.

How Long Can Patients Live with Head and Neck Cancer?

Metastatic head and neck squamous cell carcinoma patients typically have a poor prognosis. Depending on patient and disease-related characteristics, the median survival in most series ranges to 15 months. Care that is symptom-focused is crucial in the management of these patients.

8.

Is Cancer in the Neck Lymph Nodes Curable?

Many head and neck cancers are treatable, especially if they are diagnosed early. Although the major goal of treatment is to eradicate cancer, it's also crucial to maintain the function of the neighboring nerves, organs, and tissues.

9.

Can Radiation of the Neck Affect the Brain?

Serious issues include memory loss, stroke-like symptoms, and brain function can be among them.

10.

What Are the Adverse Effects of Radiation Therapy for Neck Cancer?

Those who get radiation to the head and neck may experience adverse effects like soreness in the mouth or throat (or even open sores), dry mouth, difficulty swallowing, altered taste, nausea, earaches, tooth decay, and neck, throat, or gum swelling are other symptoms to watch out for.

11.

What Can Patients Not Do During Radiation Treatment?

Alcohol can exacerbate the fatigue that radiotherapy can cause. It is crucial to avoid driving or operating machinery if a patient is feeling fatigued or lightheaded. If patients are uncertain if one can consume alcohol, ask the doctor or radiographer.

12.

How Long Before Radiation Kills Cancer Cells?

Radiation therapy does not instantly eradicate cancer cells. Before cancer cells experience enough DNA damage to cause them to die, days or weeks of treatment are required. Afterward, weeks or months after radiation therapy has finished, cancer cells continue to perish.

13.

Do Tumors Grow Back after Radiation?

If radiotherapy does not completely eradicate the cancer cells, they will eventually recur. We now know more about the radiotherapy process. Some targeted cancer treatments or immunotherapies may completely eradicate cancer. Others might make cancer smaller.

14.

Do They Shave the Head for Radiation?

Consider shaving off a portion of hair before treatment if patients receive radiation therapy to the head or scalp. Some claim that they feel more in control because of this. Put on a wig, a hair extension, or go bald.

15.

What Is the Solution to Neck Cancer?

Surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy are the primary forms of treatment. A treatment plan may include surgery, radiation therapy, or a combination of these procedures. There are more treatment specifics in each section for a particular cancer type.
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Dr. Bhatia Jatin Vinod
Dr. Bhatia Jatin Vinod

Radiation Oncology

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cancer
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