Controversies in patients with head and neck tumours undergoing radiotherapy: the need for adaptive radiotherapy.

Abstract

[EN]The treatment of head and neck tumours is based on surgery, radiotherapy and chemotherapy. The choice of each of them or their combination depends on the stage of the tumour: in early stage tumours, radiotherapy and surgery obtain similar results and both are valid, while in advanced stages all the mentioned treatments are usually combined. As far as the use of radiotherapy is concerned, its major disadvantage is based on the possible radiation of healthy tissues, such as the parotid glands. Patients with head and neck tumours suffer from mucositis and dysphagia and are more susceptible to anatomical changes during radiotherapy treatment (which may last 6-7 weeks), due to weight loss or changes in tumour size. This causes the radiation dose received by both tumour and healthy tissues to be different from that initially planned, which increases the risk of adverse effects such as xerostomia (due to an increase in the dose received by the parotid glands). The only way to compensate for the anatomical changes is to re-plan the radiotherapy treatment, a process which is called adaptive radiotherapy. The present retrospective study included 85 consecutive patients with locally advanced head and neck tumours, who received surgery ± postoperative radiotherapy or radio- chemotherapy treatment with radical intent. The predisposing factors that cause anatomical changes during radiotherapy leading to a deviation of the dose received by healthy peritumoral tissues were analysed. According to the results, patients who lose weight during radiotherapy (especially >5%) or who receive concomitant chemotherapy are highly susceptible to require adaptive radiotherapy and therefore require close follow-up for early detection and to reduce the side effects of radiotherapy.