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Review
. 2008 Jun;35(3):236-50.
doi: 10.1053/j.seminoncol.2008.03.003.

New developments in radiation therapy for head and neck cancer: intensity-modulated radiation therapy and hypoxia targeting

Nancy Y Lee  1 , Quynh-Thu Le
Affiliations
Review

New developments in radiation therapy for head and neck cancer: intensity-modulated radiation therapy and hypoxia targeting

Nancy Y Lee et al. Semin Oncol. 2008 Jun.

Abstract

Intensity-modulated radiation therapy (IMRT) has revolutionized radiation treatment for head and neck cancers (HNCs). When compared to the traditional techniques, IMRT has the unique ability to minimize the dose delivered to normal tissues without compromising tumor coverage. As a result, side effects from high-dose radiation have decreased and patient quality of life has improved. In addition to toxicity reduction, excellent clinical outcomes have been reported for IMRT. The first part of this review will focus on clinical results of IMRT for HNC. Tumor hypoxia, or the condition of low oxygen, is a key factor for tumor progression and treatment resistance. Hypoxia develops in solid tumors due to aberrant blood vessel formation, fluctuation in blood flow, and increasing oxygen demands for tumor growth. Because hypoxic tumor cells are more resistant to ionizing radiation, hypoxia has been a focus of clinical research in radiation therapy for half a decade. Interest for targeting tumor hypoxia has waxed and waned as promising treatments emerged from the laboratory, only to fail in the clinics. However, with the development of new technologies, the prospect of targeting tumor hypoxia is more tangible. The second half of the review will focus on approaches for assessing tumor hypoxia and on the strategies for targeting this important microenvironmental factor in HNC.

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Figures

Figure 1
Figure 1
An example of a T4N0 nasopharyngeal carcinoma treated with IMRT.
Figure 2
Figure 2
An example of a T3N0 base of tongue cancer treated with IMRT.
Figure 3
Figure 3
An example of a T3N1 laryngeal carcinoma treated with IMRT.
Figure 4
Figure 4
Cancer-specific survival by hypoxia marker score comprised of Galectin-1, Ephrin A1, Lysyl Oxidase, CA IX cytoplasmic and CA IX membrane staining, where a score of 1 was assigned to strong staining for each marker and a score of 0 to negative and week staining. This has been adjusted for age and hemoglobin levels, 2 other significant factors on univariate analysis.
See this image and copyright information in PMC

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