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Recent advances in the oncological management of head and neck cancer and implications for oral toxicity

British Dental Journal volume 233, pages 737–743 (2022)Cite this article

Abstract

Radiotherapy is a key treatment modality for cancers of the head and neck, being used for curative intent either alone or in combination with surgery and chemotherapy. The treatment-related toxicities of these treatments can be significant in both the short and longer term. Many of these toxicities manifest orally, even in patients whose primary malignancy was outside the oral cavity, as radiotherapy often involves elective treatment of high-risk areas, such as locally draining lymph nodes in the neck. Reducing the burden of treatment is an area of intense focus in head and neck oncology. New technology and imaging techniques, such as proton therapy and magnetic resonance imaging, are being integrated into radiotherapy treatment to minimise radiation dose outside of the target areas. In parallel, tumour biology is being explored as a means of identifying patients who might be suitable for de-escalated therapy. This review will cover the latest advances in the oncology treatment available for patients with head and neck cancers, with a focus on how these might help reduce oral toxicity.

Key points

  • Radiotherapy plays a major role in the curative treatment of head and neck cancers but is associated with significant toxicities.

  • Advances in the delivery of radiotherapy, such as intensity modulation and magnetic resonance imaging, are resulting in reduced toxicity.

  • De-escalation of treatment regimens based on risk stratification of head and neck cancers is an area of ongoing research.

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Funding

We acknowledge National Institute for Health Research funding to the Royal Marsden and Institute of Cancer Research Biomedical Research Centre. Ben O'Leary is supported by a Cancer Research UK Radiation Research Centre of Excellence at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust (grant ref: A28724) and The International Centre for Recurrent Head and Neck Cancer (IReC) at The Royal Marsden Hospital.

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  1. Clinician Scientist, The Institute of Cancer Research, London, UK; Consultant Clinical Oncologist, The Royal Marsden Hospital, London, UK

    Ben O´Leary

  2. Internal Medicine Trainee, Imperial College Healthcare NHS Trust, UK

    Adam Young

  3. Consultant Clinical Oncologist, The Royal Marsden Hospital, London, UK

    Christopher Nutting

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Ben O'Leary and Christopher Nutting conceived the manuscript and wrote the first draft. Ben O'Leary, Adam Young and Christopher Nutting contributed to writing, reviewing, editing and approving the manuscript.

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Correspondence to Ben O´Leary.

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O´Leary, B., Young, A. & Nutting, C. Recent advances in the oncological management of head and neck cancer and implications for oral toxicity. Br Dent J 233, 737–743 (2022). https://doi.org/10.1038/s41415-022-5195-5

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