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Purpose: To conduct a comprehensive narrative review of the evidence for radiotherapy target volumes to the neck, after neck dissection, for head and neck squamous cell carcinoma from an unknown primary (HNSCCUP). Inclusion or exclusion of mucosal irradiation is not the focus of interest for this review article., Materials and Methods: Literature (PubMed-Medline, EMBASE database and Cochrane library) was searched using the relevant keywords. The search results were limited to the studies published in year 2000 or after., Results: Eight studies met the inclusion criteria. All studies were retrospective in nature. The incidence of contralateral recurrence rates in the untreated neck when the involved neck only is treated remains very low (0%-10%). Survival has improved over the past two decades, most likely due to improved diagnostic techniques and the increase in incidence of HPV-related disease., Conclusion: Given the rarity of disease, level one evidence from randomised controlled trials is lacking. Available data are retrospective but support unilateral post-operative radiotherapy as a treatment option in selected cases., (© 2024 John Wiley & Sons Ltd.)

Background: Delays to postoperative radiotherapy (PORT) are frequent and associated with poorer oncologic outcomes in head and neck cancer (HNC) patients. Free flap patients have been suggested as the most at-risk group. Thus, PORT delivery experienced by HNC patients who required a free flap reconstruction was analysed, identifying reasons for the delays if any., Methods: A retrospective analysis of a single tertiary unit's PORT delivery to HNC patients undergoing major resection followed by free flap reconstruction between 2017 and 2020., Results: Eighty-seven patients were identified. Thirty-two patients received PORT within 6 weeks of their surgery date. Reasons for the delays could be categorised into surgery-derived, system-derived and patient-derived reasons. Five patients (5.74%) received PORT >6 weeks after their surgery due to surgical complications. No patients experienced surgical complications during their PORT., Conclusion: In our experience, surgical aspects of free flap reconstructions do not appear to overtly delay or interrupt PORT., Competing Interests: Conflict of interest statement None to declare., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: This study reports oncological outcomes of transoral robotic surgery (TORS) and neck dissection (ND) alone for head and neck squamous cell carcinoma (HNSCC) and aims to analyse the influence of resection margins on local recurrence rates., Materials and Methods: Fifty-one patients treated with curative intent for HNSCC, with TORS and ND alone between 2013 and 2019 at two tertiary centres were included in this observational multi-centre prospective cohort study. Oncological outcomes are reported on 47 patients for whom the aim was to treat with TORS and ND alone; this excluded four patients who were recommended adjuvant radiotherapy based on resective pathology but did not receive treatment. Local control is the primary endpoint; disease specific, progression free and overall survival are secondary outcomes., Results: With a median follow up of 43 months, estimated outcomes at 3 years (n = 47) were as follows: local control 92%, progression free survival 80%, disease specific survival 94%, and overall survival 84%. Presence of a positive margin on the main specimen was the only statistically significant predictor of local recurrence on univariate Cox regression analysis. Time dependent receiver operating characteristic curve identified margins of 1.1 mm as a threshold for local control, with area under the curve 0.788 (95% CI 0.616-0.960), indicating a good classifier., Conclusion: This is the first UK surgery alone series reporting mature oncological outcomes following TORS and ND. Positive margins on the resected specimen are the strongest predictor of local recurrence, with conventional definitions of "close margins" having no impact., (Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.)

The introduction of immunotherapy into the radical management of head and neck cancer (HNC) is a fast moving phenomenon, which is constantly developing. Although now established in the management of recurrent and metastatic disease in HNC, its use in radical treatment is being investigated in a whole spectrum of clinical trials looking at which immune altering agents give the best results, which can be added safely to radiotherapy, chemotherapy, and chemoradiotherapy for greatest efficiency and when the most appropriate time to add these agents is in the neoadjuvant, concurrent on adjuvant settings. These multiple questions produce a complex matrix for HNC investigators and this article brings together the existing evidence and contemporary trials going on with immunotherapy in HNC, giving an up to date snapshot of present investigations and near future directions for further research., (© 2021 John Wiley & Sons Australia, Ltd.)

Introduction In radiotherapy (RT) for head and neck cancer (HNC), dental morbidity is significant and it may result in loss of the dentition following treatment.Aims The aim of this clinical study is to identify the incidence of tooth loss over time and correlate this to the RT dose and various risk factors in patients with HNC treated with radical RT.Design A retrospective observational study.Materials and methods The records of 1,118 patients with HNC treated with radical or adjuvant RT from January 2010 to December 2019 were analysed. After applying strict inclusion criteria, 78 patients with 1,566 individual tooth data were selected. RT dose mapping was performed for each tooth.Results A total of 253 teeth (16.2%) were extracted. The following risk factors were significant: gender (p = 0.0001), xerostomia (p <0.0001), RT dose (p <0.0001) and smoking (p <0.0001). Non-significant factors were age, RT delivery technique and the addition of cisplatin.Conclusion Detailed RT dose mapping was used to identify RT dose as a risk factor for dental loss. Careful pre-RT dental treatment and minimisation of RT dose to teeth and salivary glands is required to prevent or reduce the loss of dentition., (© 2021. The Author(s), under exclusive licence to the British Dental Association.)

Objectives: To assess the efficacy of the second measured glomerular filtration rate (GFR) during the course of weekly cisplatin-based chemoradiotherapy in head and neck cancer., Methods: Data was collected on consecutive 221 head and neck cancer patients who underwent cisplatin-based chemoradiotherapy., Results: 68% patients managed to complete at least five out six proposed cycles of cisplatin, with a cumulative dose of ≥200 mg/m 2 . 181 patients underwent second measured GFR and it showed a mean fall in measured GFR by 12.0 ml/min/1.73 m 2 ( p < 0.0001). Out of these 181 patients, in 16 patients (9%), the decision to discontinue cisplatin was purely based on a low second measured GFR (below 50 ml/min/1.73 m 2 )., Conclusion: Our study has shown that obtaining a second measured GFR is valuable in 9% of these patients. We propose that this should be considered as a standard procedure in these settings and also should be considered incorporating this additional safety measure, into future clinical trials as a mandatory procedure., Advances in Knowledge: To the best of author's knowledge, this is first study of its kind. The results of our study suggest that it should be a standard procedure of obtaining a second GFR in these settings.

Objectives: Stereotactic radiotherapy (SBRT) is gaining popularity although its use in head and neck cancer (HNC) is not well defined. The primary objective was to review the published evidence regarding the use of stereotactic radiotherapy in HNC., Methods: A literature search was performed by using MEDLINE and EMBASE databases for eligible studies from 2000 to 2019 and 26 relevant studies were identified., Results: Literature demonstrates a heterogeneous use of this technique with regards to patient population, primary or salvage treatment, dose fractionation regimens, outcomes and follow-up protocols. Carotid blow out syndrome is a risk as with other forms of reirradiation but alternative treatment regimens may reduce this risk., Conclusion: At present there is a lack of evidence regarding SBRT as a primary treatment option for HNC and definitive answers regarding efficacy and tolerability cannot be provided but there is growing evidence that SBRT reirradiation regimens are safe and effective. In lieu of evidence from large Phase III trials, we define appropriate organ at risk constraints and prescription doses, with accurate plan summation approaches. Prospective randomised trials are warranted to validate improved treatment outcomes and acceptable treatment morbidity., Advances in Knowledge: This article provides a comprehensive review of evidence of use of stereotactic radiotherapy in HNC site (either as a primary treatment or as reirradiation). We also provide an evidence-based approach to the implementation and practical consideration of stereotactic radiotherapy in HNC.

Managing older patients with head and neck cancers poses a challenge due to the often reduced levels of physiological reserve, the frequent comorbidities and treatment related toxicity. These factors have implications on speech, breathing and swallowing functions. Treatment management plans in these patients may result in de-intensification strategies and as a result of this, use of non-standard treatments is increasing. There have been published reports that indicate the addition of concurrent systemic therapy to radiation in selected older patients is feasible, and produces outcomes comparable with younger patients. However, some other studies including meta-analyses suggest a lack of real survival benefit with the addition of chemotherapy. So, the key point appears to be the optimal patient selection. Appropriate geriatric and frailty assessments are required to help determine the optimal treatment for older patients with head and neck cancer. Treatment for this population still needs to be well defined and optimized in both modality and intensity. Qualitative studies are also required to address short and long-term post-treatment quality-of-life and survivorship issues in this specific patient population. This review summarizes the evidence available regarding the non-surgical management of older patients with head and neck cancers., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)