Radiation Therapy for Head and Neck Cancers
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1 Radiation Therapy for Head and Neck Cancers
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3 Murat Beyzadeoglu Gokhan Ozyigit Ugur Selek Editors Radiation Therapy for Head and Neck Cancers A Case-Based Review
4 Editors Murat Beyzadeoglu, MD Professor and Chairman Department of Radiation Oncology Gulhane Military Medical School Ankara Turkey Ugur Selek, MD Professor and Chairman Department of Radiation Oncology Koc University, Faculty of Medicine Istanbul Turkey Gokhan Ozyigit, MD Professor and Chairman Department of Radiation Oncology Hacettepe University Faculty of Medicine Ankara Turkey ISBN ISBN (ebook) DOI / Springer Cham Heidelberg New York Dordrecht London Library of Congress Control Number: Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (
5 Dedicated to the memory of Professor Kie Kian Ang, MD, PhD ( )
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7 Preface Head and neck region is a challenging region of the body, containing critical parts associated with basic physiological functions including respiration, nutrition, and expression. Debilitating consequences may occur as a result of head and neck cancers depending on location, size, and spread pattern of the tumors. Structural disfiguration and functional impairments may considerably compromise social integration and quality of life. Therefore, optimal management of head and neck cancer patients requires a multidisciplinary team approach with the endpoint of functional survival. The intent of writing Radiation Therapy for Head and Neck Cancers A Case- Based Review was to provide a structured, comprehensive Head & Neck book to furnish the practicing healthcare providers with a contemporary evidence-based management guide to fulfill the goal of having cured but functionally unimpaired patients. Each clinical chapter includes several head and neck cancer cases for the demonstration of target volume delineation and intensity-modulated radiotherapy treatment planning. Several cross-sectional slices of both contouring and planning images are included in order to give a more complete picture for each clinical case. Three chapters cover the general management issues, systemic therapies, and complications of head & neck radiotherapy. Furthermore, important clinical trials are also provided for evidence-based management in each head & neck subsite. In summary, readers can find every practical and theoretical aspect of modern radiotherapy approach from consultation phase to treatment delivery stage in Radiation Therapy for Head and Neck Cancers A Case-Based Review. We extend our most sincere gratitude to our patients teaching us invaluable lessons more than we can learn from books while they are suffering from physical and mental pain in their combat with cancer. Ankara, Turkey, 2014 Ankara, Turkey, 2014 Istanbul, Turkey, 2014 Murat Beyzadeoglu, MD Gokhan Ozyigit, MD Ugur Selek, MD vii
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9 Acknowledgements The editors are indebted to Ute Heilman, Corinna Schäfer, and Wilma McHugh from Springer DE and Kalpana Venkatramani and Mahalakshmi SathishBabu from SPi for their assistance in preparing Radiation Therapy for Head and Neck Cancers: A Case-Based Review. We extend our most sincere gratitude to Professor Hayati Bilgic, the dean of Gulhane Military Medical School, and to our colleagues and friends at Gulhane Military Medical School, Faculty of Medicine at Hacettepe University, Koc University, and Baskent University, as well as to our families for their understanding as we worked to meet our publication deadlines. ix
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11 Contents 1 General Concepts in Head and Neck Radiotherapy Murat Beyzadeoglu, Omer Sager, and Ferrat Dincoglan 2 Current Systemic Therapy Options for Head and Neck Cancers Mehmet Ali Nahit Sendur and Sercan Aksoy 3 Management of the Neck Gokhan Ozyigit, Sezin Yuce Sari, Melis Gultekin, Gozde Yazici, Pervin Hurmuz, and Mustafa Cengiz 4 Nasal Cavity and Paranasal Sinuses Gozde Yazici, Sezin Yuce Sari, Mustafa Cengiz, Pervin Hurmuz, Melis Gultekin, and Gokhan Ozyigit 5 Oral Cavity Sezin Yuce Sari, Gokhan Ozyigit, Melis Gultekin, Gozde Yazici, Pervin Hurmuz, Mustafa Cengiz, and Murat Beyzadeoglu 6 Nasopharynx Ugur Selek, Yasemin Bolukbasi, Erkan Topkan, and Gokhan Ozyigit 7 Oropharynx Ugur Selek, Yasemin Bolukbasi, Yucel Saglam, Erkan Topkan, and Gokhan Ozyigit 8 Hypopharyngeal Cancer Erkan Topkan, Berna Akkus Yildirim, Cem Parlak and Ugur Selek 9 Laryngeal Cancer Erkan Topkan, Berna Akkus Yildirim, Cem Parlak, and Ugur Selek xi
12 xii Contents 10 Salivary Gland Melis Gultekin, Sezin Yuce Sari, Gokhan Ozyigit, Mustafa Cengiz, Gozde Yazici, Pervin Hurmuz, and Murat Beyzadeoglu 11 Metastatic Cancer in Neck Node with Occult Primary Erkan Topkan, Berna Akkus Yildirim, and Cem Parlak 12 Complications of Head and Neck Radiotherapy and Management Murat Beyzadeoglu, Ferrat Dincoglan, and Omer Sager Index
13 Contributors Sercan Aksoy, MD Associate Professor, Department of Medical Oncology, Hacettepe University, Cancer Institute, Sihhiye, Ankara, Turkey Murat Beyzadeoglu, MD Professor and Chairman, Department of Radiation Oncology, Gulhane Military Medical School, Etlik, Ankara, Turkey Yasemin Bolukbasi, MD Associate Professor, Department of Radiation Oncology, MD Anderson Radiation Treatment Center, American Hospital, Nisantasi, Istanbul, Turkey Mustafa Cengiz, MD Professor, Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Sihhiye, Ankara, Turkey Ferrat Dincoglan, MD Assistant Professor, Department of Radiation Oncology, Gulhane Military Medical School, Etlik, Ankara, Turkey Melis Gultekin, MD Assistant Professor, Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Sihhiye, Ankara, Turkey Pervin Hurmuz, MD Assistant Professor, Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Sihhiye, Ankara, Turkey Gokhan Ozyigit, MD Professor and Chairman, Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Sihhiye, Ankara, Turkey Cem Parlak, MD Assistant Professor, Department of Radiation Oncology, Baskent University, Faculty of Medicine, Adana, Turkey Omer Sager, MD Assistant Professor, Department of Radiation Oncology, Gulhane Military Medical School, Etlik, Ankara, Turkey Yucel Saglam, MSc Radiotherapy Physicist, Department of Radiation Oncology, MD Anderson Radiation Treatment Center, American Hospital, Nisantasi, Istanbul, Turkey xiii
14 xiv Contributors Sezin Yuce Sari, MD Instructor, Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Sihhiye, Ankara, Turkey Ugur Selek, MD Professor and Chairman, Department of Radiation Oncology, Koc University, Faculty of Medicine, Nisantasi, Istanbul, Turkey Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA Mehmet Ali Sendur, MD Assistant Professor, Department of Medical Oncology, Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey Erkan Topkan, MD Associate Professor and Chairman, Department of Radiation Oncology, Baskent University, Faculty of Medicine, Adana, Turkey Gozde Yazici, MD Associate Professor, Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Sihhiye, Ankara, Turkey Berna Akkus Yildirim, MD Instructor, Department of Radiation Oncology, Baskent University, Faculty of Medicine, Adana, Turkey
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