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Radiation therapy plays an essential role in the treatment of head and neck squamous cell carcinoma (HNSCC), yet therapeutic efficacy is hindered by treatment-associated toxicity and tumor recurrence. In comparison to other cancers, innovation has proved challenging, with the epidermal growth factor receptor (EGFR) antibody cetuximab being the only new radiosensitizing agent approved by the FDA in over half a century. This review examines the physiological mechanisms that contribute to radioresistance in HNSCC as well as preclinical and clinical data regarding novel radiosensitizing agents, with an emphasis on those with highest translational promise.

Background: Fifth metacarpal fractures are often treated nonoperatively with serial radiographs; however, the utility of these radiographs in altering clinical management has not been investigated. We hypothesize that follow-up plain films will not alter clinical management and are therefore unnecessary for most patients. Methods: Between 2007 and 2014, patients with a fifth metacarpal fracture at our level I trauma center were retrospectively reviewed. Patients with inadequate documentation or imaging, ipsilateral upper extremity injuries, or who underwent initial surgical fixation were excluded. Initial and postreduction radiographs were reviewed by 4 board-certified attending hand surgeons and 2 hand fellows who indicated their preferred management. At a later date, blinded to their initial management, the reviewers assessed follow-up films taken at least 2 weeks later and indicated their preferred management. Results: In total, 60 patients met inclusion criteria, and of those, 30 were randomly selected. There were 9 base, 7 shaft, and 14 neck fractures. Initially, reviewers opted for nonoperative management in 72.2% of base, 71.4% of shaft, and 91.7% of neck fractures. After reviewing follow-up films, reviewers changed from nonoperative to operative management in 0.0% of base, 9.5% of shaft, and 1.2% of neck fractures. Conclusions: Follow-up radiographs may not be indicated for most fifth metacarpal base and neck fractures. Follow-up radiographs may change management in select fifth metacarpal shaft fractures as these fractures may displace. Follow-up radiographs should be performed at the discretion of the treating surgeon on an as-needed basis for fractures at risk for displacement.