Update in the management of head and neck cancer

Patients with head and neck cancer present numerous challenges to treating physicians. The optimum management requires a co-ordinated, multispeciality team, comprising experienced head and neck surgeons, medical and radiation oncologists, pathologists, diagnostic radiologists and nuclear medicine physicians. The improved survival observed with CRT using high-dose cisplatin over RT alone warrants its use as standard care for fit patients with high risk SCCHN following surgery or as definitive therapy for patients with unresectable disease. Patients with unresectable disease also have better survival with induction CT and RT compared to RT alone. However, when the goal of therapy is preservation of the larynx, CRT is superior to both induction CT followed by RT, and RT alone. Drugs that inhibit the EGFR pathway, alone or in combination with radiation, appear promising in the treatment of patients with unresectable disease and with recurrent or metastatic disease. Local control rates may improve with wider utilization of altered fractionation schedules in CRT regimens. Intensity modulation and PET-CT fusion are improved means to target and accurately deliver radiation therapy to the head and neck. Endoscopic laser surgery and supracricoid partial laryngectomy can improve organ preservation in suitable patients.