Has innovations in radiotherapy for head and neck cancer improved patients curability?

Abstract

In the era of distinct technological innovations in radiotherapy, clinically important question arises has the increase of the RT effectiveness been achieved due to these innovations, at least in case of the head and neck (H&N) cancers. To answer to this question 133 studies published in the literature, including 21 058 patients with H&N cancer treated in the period a 1970-2010 years were selected to the present survey. Three end-points, e.g. 5-year local tumour control (LTC), disease-free survival (DFS) and overall survival (OS) and its averages have been evaluated in the consecutive decades of time. For cancer in the early stage, both LTC and DFS were constantly high (80–90%) through the analyzed decades. For locally advanced cancer, average rates of the LTC and an DFS were also constant, but much lower (40-45%) than expected. The OS has an increasing tendency from 45–50% in 1980 to more than 70% in 2010. It may suggest that during the 5-year follow-up some rate (~20%) of advanced tumours gradually progressed from local to chronic disease. Various technical and clinical problems influencing the results of the present review are discussed in details. Some uncertainties and doubts regarding the RT trials may suggest that “ evidence based ” recommendations are not a good ambassador enough, and in the era of combined treatment modalities it may seem reasonably to replace it by “ individually personalized combined therapy ” . However, nowadays the only plausible solution to improve H&N curability is to intensify all efforts to detect H&N cancer in a very early stage of disease and to increase various activities to convince people to participate in regular prophylactic examinations.