Head and neck cancers volume reduction: should we reduce our prophylactic node radiation to spare the antitumor immune response?

Abstract

Radiotherapy for locally advanced head and neck cancer classically include large prophylactic node volume. However, the use of these large volumes can be responsible for significant toxicity. Furthermore, the disappointing results of radioimmunotherapy combinations in head and neck tumors raise concerns about radiotherapy's potential negative impact on the immune response when large lymph node volumes are treated. Besides, in other tumor locations, such as lung cancers, the volumes of elective irradiation have been considerably reduced, with the same local control as before. This opinion piece reviews the current state of radiation volumes in head and neck cancers, the rationale for these volumes, the potential impact of radiotherapy on immune response, and the volume changes that would improve the efficacy of radioimmunotherapy combinations.

Keywords: Cancers tête et cou; Elective neck irradiation; Head and neck cancer; Immunotherapy; Immunothérapie; Radiotherapy; Radiothérapie; Reduction volume.