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  • Review Article
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Organ-sparing radiation therapy for head and neck cancer

Nature Reviews Clinical Oncology volume 8, pages 639–648 (2011)Cite this article

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Abstract

To improve locoregional tumor control and survival in patients with locally advanced head and neck cancer (HNC), therapy is intensified using altered fractionation radiation therapy or concomitant chemotherapy. However, intensification of therapy has been associated with increased acute and late toxic effects. The application of advanced radiation techniques, such as 3D conformal radiation therapy and intensity-modulated radiation therapy, is expected to improve the therapeutic index of radiation therapy for HNC by limiting the dose to critical organs and possibly increasing locoregional tumor control. To date, Review articles have covered the prevention and treatment of radiation-induced xerostomia and dysphagia, but few articles have discussed the prevention of hearing loss, brain necrosis, cranial nerve palsy and osteoradionecrosis of the mandible, which are all potential complications of radiation therapy for HNC. This Review describes the efforts to prevent therapy-related complications by presenting the state of the art evidence regarding advanced radiation therapy technology as an organ-sparing approach.

Key Points

  • Xerostomia can be reduced by limiting the mean dose to 26 Gy for one parotid gland, ≤39 Gy to the noninvolved submandibular glands and ≤30 Gy to the oral cavity

  • Late dysphagia can be reduced by keeping the mean dose ≤50 Gy to the non-involved pharyngeal constrictor muscles and the larynx

  • Hearing loss might be reduced by limiting the dose to the inner ear to <45–54 Gy

  • Late temporal lobe radiation necrosis could decline if the temporal lobes are treated with a maximum dose of <60 Gy, or if 1% of the temporal lobe volume receives <65 Gy

  • By limiting the maximum dose to the optic nerve and chiasm to 54 Gy, the risk of late radiation-induced optic neuropathy can be minimized

  • Reductions in dose to the salivary glands and mandible are likely to translate into reduced incidence of xerostomia and osteoradionecrosis for patients with HNC

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Figure 1: A parotid-sparing intensity-modulated radiation therapy plan for a patient with T2N0 nasopharyngeal cancer.
Figure 2: A clinical example of an intensity-modulated radiation therapy plan aiming to reduce dysphagia for a patient with T2N0 nasopharyngeal cancer.

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Authors and Affiliations

  1. Department of Radiation Oncology, Cancer Hospital, Fudan University, 270 Dong'an Road, Shanghai, 200032, China

    XiaoShen Wang & ChaoSu Hu

  2. Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, UH B2C490, Ann Arbor, 48109–0010, MI, USA

    Avraham Eisbruch

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  1. XiaoShen Wang
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All authors contributed to the research of data, the discussion of content and the revision of the manuscript. X. Wang and A. Eisbruch contributed significantly to the writing of the original submission.

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Correspondence to ChaoSu Hu.

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Wang, X., Hu, C. & Eisbruch, A. Organ-sparing radiation therapy for head and neck cancer. Nat Rev Clin Oncol 8, 639–648 (2011). https://doi.org/10.1038/nrclinonc.2011.106

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