Function Preservation in Head and Neck Cancers

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 35; no. 8; pp. 497 - 506
• Main Authors: Budrukkar, A., Guinot, J.L., Tagliaferri, L., Bussu, F., García-Consuegra, A., Kovacs, G.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2023
• Subjects: Brachytherapy; Brachytherapy - methods; Carcinoma, Squamous Cell - pathology; Dental Caries; function preservation; head and neck cancers; Head and Neck Neoplasms - radiotherapy; Humans; organ preservation; Quality of Life; Radiotherapy Dosage; Xerostomia; NPC; CTV; IMRT; CRT; GTV; head and neck cancers; PNS; function preservation; HDR; Brachytherapy; 3DCRT; LDR; organ preservation; EBRT
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2023.01.022

The treatment of head and neck cancers can have a significant impact on function and appearance, which results in impairment of quality of life. Various long-term sequelae of treatment include speech and swallowing difficulty, oral incompetence, trismus, xerostomia, dental caries and osteoradionecrosis. Management has evolved from single modality treatment of either surgery or radiation to multimodality treatment to attain acceptable functional outcomes. Brachytherapy, also known as interventional radiotherapy, with its ability to deliver high doses centrally to the target, has been shown to improve local control rates. Due to the rapid fall-off of the dose of brachytherapy there is better organ at risk sparing as compared with that of external beam radiotherapy. In the head and neck region, brachytherapy has been practiced in various sites, including the oral cavity, oropharynx, nasopharynx, nasal vestibule and paranasal sinuses. Additionally, brachytherapy has also been considered for reirradiation as a salvage. Brachytherapy can also be considered as a perioperative technique together with surgery. Close multidisciplinary cooperation is required for a successful brachytherapy programme. In oral cavity cancers, depending on the location of the tumour, brachytherapy has been shown to preserve oral competence, maintain tongue mobility, maintain speech, swallowing and the hard palate. Brachytherapy in oropharyngeal cancers has been shown to reduce xerostomia and also reduce dysphagia and aspiration post-radiation therapy. For the nasopharynx, paranasal sinus and nasal vestibule, brachytherapy preserves the respiratory function of the mucosa. Despite such an incomparable impact on function and organ preservation, brachytherapy is an underutilised technique for head and neck cancers. There is a strong need to improve brachytherapy utilisation in head and neck cancers. •Brachytherapy results in function preservation in head and neck cancer.•Function preservation has been achieved in various subsites, such as oral cavity, oropharynx, nasopharynx, paranasal sinuses and nasal vestibule.•Brachytherapy with or without external beam irradiation should be integrated in the routine management of head and neck cancers for optimal outcomes.