Overcoming Resistance to Immunotherapy in Head and Neck Cancer Using Radiation: A Review

Radiation therapy remains at the center of head and neck cancer treatment. With improvements in treatment delivery, radiation therapy has become an affective ablative modality for head and neck cancers. Immune checkpoint inhibitors are now also playing a more active role both in the locally advanced and metastatic setting. With improved systemic options, local noninvasive modalities including radiation therapy are playing a critical role in overcoming resistance in head and neck cancer. The aim of this review is to describe the role of radiation therapy in modulating the tumor microenvironment and how radiation dose, fractionation and treatment field can impact the immune system and potentially effect outcomes when combined with immunotherapy. The review will encompass several common scenarios where radiation is used to improve outcomes and overcome potential resistance that may develop with immunotherapy in head and neck squamous cell carcinoma (HNSCC), including upfront locally advanced disease receiving definitive radiation and recurrent disease undergoing re-irradiation. Lastly, we will review the potential toxicities of combined therapy and future directions of their role in the management of HNSCC.

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A phase II study of docetaxel and carboplatin with concurrent radiation therapy for locally advanced head and neck cancer

Auris Nasus Larynx ◽

10.1016/j.anl.2010.05.012 ◽

2011 ◽

Vol 38 (1) ◽

pp. 108-113 ◽

Cited By ~ 5

Author(s):

Imjai Chitapanarux ◽

Vicharn Lorvidhaya ◽

Ekasit Tharavichitkul ◽

Somvilai Mayurasakorn ◽

Pichit Sittitrai ◽

...

Keyword(s):

Radiation Therapy ◽

Head And Neck Cancer ◽

Head And Neck ◽

Phase Ii ◽

Neck Cancer ◽

Phase Ii Study ◽

Locally Advanced ◽

Advanced Head

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Comparison of Quality of Life (QOL) in Patients With Locally Advanced Head-and-Neck Cancer Prior and 1 Year After the Completion of Radiation Therapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2012.07.1731 ◽

2012 ◽

Vol 84 (3) ◽

pp. S649 ◽

Cited By ~ 1

Author(s):

P. Milecki ◽

M. Zmijewska-Tomczak

Keyword(s):

Quality Of Life ◽

Radiation Therapy ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Locally Advanced ◽

Advanced Head

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Adaptive radiotherapy for head and neck cancer

Radiološke tehnologije ◽

10.48026/isnn.26373297.2020.11.1.2 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Enis Tinjak ◽

Velda Smajlbegović ◽

Adnan Beganović ◽

Mirjana Ristanić ◽

Halil Ćorović ◽

...

Keyword(s):

Radiation Therapy ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Locally Advanced ◽

Adaptive Radiotherapy ◽

Tumor Control ◽

Parotid Glands ◽

Image Guided Radiotherapy ◽

The Impact

Introduction: Radiation therapy has long played an integral role in the manage¬ment of locally advanced head and neck cancer (HNC), both for organ preservation and to improve tumor control in the postoperative setting. The aim of this research is to investigate the effects of adaptive radiotherapy on dosimetric, clinical, and toxicity outcomes for patients with head and neck cancer undergoing radiation therapy treatment. Many sources have reported volume reductions in the primary target, nodal volumes, and parotid glands over treatment, which may result in unintended dosimetric changes affecting the side effect profile and even efficacy of the treatment. Adaptive radiotherapy (ART) is an interesting treatment paradigm that has been developed to directly adjust to these changes.Material and methods: This research contains the results of 15 studies, including clinical trials, randomized prospective and retrospective studies. The researches analyze the impact of radiation therapy on changes in tumor volume and the relationship with planned radiation dose delivery, as well as the possibility of using adaptive radiotherapy in response to identified changes. Also, medical articles and abstracts that are closely related to the title of adaptive radiotherapy were researched.Results: The application of ART significantly improved the quality of life of patients with head and neck cancer, as well as two-year locoregional control of the disease. The average time to apply ART is the middle of the treatment course approximately 17 to 20 fractions of the treatment.Conclusion: Based on systematic review of the literature, evidence based changes in target volumes and dose reduction at OAR, adaptive radiotherapy is recommended treatment for most of the patients with head and neck cancer with the support of image-guided radiotherapy.

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