Head and Neck Cancer Treatment with Modern Radiation Techniques

The most prevalent cancer in India, accounting for one-third of all cancer cases, is head and neck cancer. According to the Indian Council of Medical Research, between 0.2 million and 0.25 million new cases of head and neck cancer are identified each year (ICMR).

There are many potential locations for head and neck cancers, including the mouth, throat, larynx (voice box), salivary glands, sinuses, muscles, and nerves. Squamous cell carcinomas are malignancies that develop in the squamous cells of the mucosal lining of the head and neck (mouth, throat, and voicebox). Squamous cell carcinomas are more prevalent than other types of head and neck cancer.

Why do head and neck cancers develop?

The causes of head and neck cancer include:

• Consuming tobacco: Smoking cigarettes, using betel quid laced with tobacco, using snuff, and other forms of tobacco can all increase your risk of developing head and neck cancer. Squamous cell carcinomas are primarily caused by this.
• Alcohol: Drinking can become the root cause of cancer in different parts of the body, like the throat, neck, breasts, liver, colon, rectum, etc. People who consume both tobacco and alcohol are at a greater risk of developing head and neck cancer than those who consume either one of the two.
• Betel quid (paan): It consists of betel leaf, areca nut, and slaked lime, which may or may not contain tobacco. . With or without tobacco, it can still lead to head and neck cancer.
• Human Papillomavirus (HPV) Infection: The presence of human papillomavirus can cause oropharyngeal cancers that begin in the tonsils or base of the tongue.
• Epstein-Barr virus infection: It causes cancer in the nasopharyngeal region and salivary glands.
• Radiation Exposure: Cancer of the salivary glands begins when the head and neck are exposed to radiation. 
• Occupational Exposure: Cancers of the nasopharynx, voice box, paranasal sinuses, and nasal cavity can result from exposure to wood dust, nickel dust, formaldehyde, asbestos, metal, ceramic, etc. 
• Underlying genetic disorders: A few genetic disorders like fanconi anaemia can increase the risk of developing head and neck cancer.

Head and neck cancer treatment

Depending on a number of variables, including the location of the tumour, the stage of the cancer, the patient’s age, and other medical issues, doctors may recommend a treatment strategy. Typical therapies include:

• Surgery: Surgical removal of the cancer completely is done based on the size, position, and parts where the cancer has spread.
• Chemotherapy: It is a process where powerful drugs are used to kill rapidly growing cancerous cells. 
• Radiation therapy: High-intensity beams are used to kill malignant cells and prevent them from proliferating.
• Targeted Therapy: In this process, the proteins which help in the growth, division, and spread of cancerous cells are targeted. Then a specific treatment is selected to destroy these proteins without harming the healthy cells.
• Immunotherapy: Drugs are used to strengthen or alter the immune system of the body so that it can fight the cancerous cells on its own.

Combined Modality Approach: Combining therapies like induction therapy and subsequent radiotherapy, concurrent chemotherapy and radiotherapy, etc., gives better results than single treatment procedures. These also help in reducing the side effects and in improving organ health.

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Don’t Ignore the Symptoms

Side Effects of Traditional Treatment Techniques

Following any treatment approach, quality of life can be compromised. The following are a few adverse reactions to previous treatments:

• Mucositis (ulceration or redness of mucosa of oral cavity)
• Dermatitis (skin changes)
• Xerostomia (dry mouth)
• Dysphagia (swallowing difficulty)
• Speech related problems
• Extreme tiredness
• Loss of appetite

New Radiation Therapies

Modern radiation methods and tools can aid in minimising side effects and improving quality of life. These methods concentrate more on the tumour and expose healthy cells to fewer dosages. The following methods contribute to a higher quality of life by lowering side effects and enhancing tumour control.

• Intensity Modulated Radiotherapy (IMRT): Computer controlled linear accelerators are used to deliver high-precision radiation doses to the tumour. The surrounding healthy cells are very minimally subjected to radiation doses, which helps in avoiding damage to the surrounding healthy cells.
• Arc Therapy (RapidArc): In this treatment, IMRT is completed in a single rotation of the treatment machine around the patient. It is less time-consuming than the IMRT treatment.
• Image-guided Radiotherapy (IGRT): Detailed imaging is performed before every radiation therapy. This helps in targeting the tumour with more precision and accuracy.

• Conformal radiotherapy: In this therapy, the beams of radiation are shaped like the tumour. This helps in preventing damage to the adjacent healthy cells.
• Adaptive Radiotherapy: Here, the treatment strategy may be changed in response to systemic feedback regarding the tumour’s dimensions. 
• MR-LINAC (Magnetic Resonance Image-guided-Linear Accelerator): It uses magnetic resonance imaging (MRI) along with radiotherapy to treat cancers.

Modern cancer treatments aim to not only remove the tumours but also enhance survivors’ quality of life. Additionally, it aims to lessen side effects caused during the treatment.

References

• Head and neck cancer in India: Need to formulate uniform national treatment guideline? Trivedi N P, Kekatpure V D, Trivedi N N, Kuriakose M A – Indian J Cancer
• Surgery for head and neck cancer – Macmillan Cancer Support
• Chemotherapy for Head and Neck Cancer | Memorial Sloan Kettering Cancer Center (mskcc.org)
• Radiation Therapy to the Head and Neck | Memorial Sloan Kettering Cancer Center (mskcc.org)
• Targeted Therapy: What It Is, Process & Side Effects (clevelandclinic.org)
• Immunotherapy for melanoma: Types, benefits, risks, and more (medicalnewstoday.com)
• Combined modalities in the treatment of head and neck cancers – PubMed (nih.gov)
• Adaptive radiation therapy – PubMed (nih.gov)

About Author

Dr. Kirti Ranjan Mohanty

MBBS, MD (Gold Medallist)

Consultant Radiation Oncologist

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