Adjuvant therapy for head and neck cancers

The non-surgical management of head and neck cancer has changed over the last two decades with more emphasis given now to organ preservation and post-treatment organ function. These two concepts do not necessarily go hand in hand but preserving an organ without preserving its function is pointless. In this period, for some head and neck cancers subsites, for example, oropharynx, the treatment model has moved away from primary surgery followed by planned, adjuvant radiotherapy, to one of primary chemoradiotherapy with the objective of greater organ and function preservation. This change in management strategy may be coming under further review now, with the introduction of transoral robotic surgery (TORS), where the treatment model may revert back to primary surgery with the question raised, whether highly selective TORS followed by highly selective adjuvant radiotherapy using the newer radiation technologies and techniques with intensity-modulated radiotherapy or tomotherapy, with or without chemotherapy might optimize tumour control with minimal long-term morbidity.