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Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer

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Clinical Management of Head and Neck Cancer

The management of head and neck cancer (HNC) is complex and usually involves a multidisciplinary team. In general, the approach to managing this type of cancer is dictated by the site and extent of the disease, as well as by the histologic type and grade of tumor. Early stage disease may be treated with a single modality (surgery or radiation); whereas, locally advanced disease is generally treated with combined modalities. Depending upon the extent of disease spread, a cervical lymph node dissection may be performed. Most patients with locally advanced HNC receive chemotherapy in addition to radiotherapy (chemoradiation) as a part of initial curative treatment. The integration of chemotherapy into the treatment of HNC has resulted in improvements in overall survival and local-regional control, has reduced the incidence of distant metastases, and has provided the opportunity for organ preservation in certain settings. Radiotherapy is associated with early and late toxicities, which can have a profound effect on a patient’s quality of life. Chemoradiation may be associated with enhancement of these toxicities, particularly mucositis and xerostomia. Therapy-related toxicities are particularly relevant in the treatment of HNC because of the close proximity of many important dose-limiting normal tissues. Treatment can impact basic functions like chewing, swallowing, and breathing; affect the senses (e.g., taste, smell, hearing); and significantly alter appearance and voice.