Head and Neck Cancers: Modern Management

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: 30 May 2025 | Viewed by 548

Special Issue Editors


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Guest Editor
1. Department of Oncology and Radiotherapy, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania
2. Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
Interests: radiation oncology; head and neck cancers; medical oncology

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Guest Editor Assistant
Department of Radiation Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
Interests: radiation oncology; head and neck cancers

E-Mail Website
Guest Editor Assistant
1. Department of Oncology and Radiotherapy, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania
2. Department of Radiation Oncology, Regional Institute of Oncology, 700483 Iasi, Romania
Interests: radiation oncology; head and neck cancers; medical oncology

Special Issue Information

Dear Colleagues,

Although it represents the 6th most common neoplasm, head and neck cancer is a major public health problem due to the high rates of therapeutic failure and increased mortality. The toxicities associated with multimodal therapies severely affect the quality of life (QoL) and generate significant costs associated with the medical care of these patients.

Advances in diagnostic techniques, including high-performance imaging and immunohistochemistry, but also therapeutic techniques, including robotic surgery, irradiation techniques, targeted molecular therapies and immunotherapy, have brought benefits in survival, even in advanced stages of the disease. Longer survival rates also bring pattern of disease progression and toxicities through synergistic associations of oncological therapies.

This Special Issue proposes the publication of case reports, original studies and review articles that present results of modern multimodal treatments and the toxicities related with long-term survival in locally advanced, recurrent and metastatic cases of head and neck cancer, in addition to the topics outlined below:

  • Unusual patterns of disease progression
  • A combination of radiotherapy-immunotherapy-targeted molecular therapy
  • The abscopal effect after radiation therapy and immunotherapy
  • Radio-induced secondary cancer
  • Image-guided radiotherapy techniques and stereotactic body radiosurgery (SBRT), proton therapy, carbon ion therapy, radiobiological models for toxicities
  • Financial toxicity associated with the care of heavily treated throat cancer patients
  • Modern management of oligo-metastatic disease

Prof. Dr. Lucian Miron
Guest Editor

Dr. Camil Mirestean
Dr. Dragos Teodor Iancu
Guest Editor Assistants

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Keywords

  • head and neck cancers
  • image-guided radiotherapy
  • stereotactic body radiosurgery (SBRT)
  • proton therapy
  • carbon ion therapy
  • radiobiological models
  • immunotherapy
  • targeted therapy
  • secondary cancers
  • oligo-metastatic

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Published Papers (1 paper)

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Research

14 pages, 1479 KiB  
Article
Potential Risk of Cognitive Impairment Due to Irradiation of Neural Structures in Locally Advanced Nasopharyngeal Cancer Treated by Curative Radiotherapy
by Camil Ciprian Mireștean, Călin Gheorghe Buzea, Alexandru Dumitru Zară, Roxana Irina Iancu and Dragoș Petru Teodor Iancu
Medicina 2025, 61(5), 810; https://doi.org/10.3390/medicina61050810 - 27 Apr 2025
Viewed by 263
Abstract
Background and Objectives: Brain radionecrosis is an under-recognized but potentially life-altering late complication of radiotherapy in patients with locally advanced nasopharyngeal cancer. Temporal lobe radionecrosis and high-dose exposure to the hippocampus are strongly associated with cognitive decline and radiation-induced dementia, negatively impacting [...] Read more.
Background and Objectives: Brain radionecrosis is an under-recognized but potentially life-altering late complication of radiotherapy in patients with locally advanced nasopharyngeal cancer. Temporal lobe radionecrosis and high-dose exposure to the hippocampus are strongly associated with cognitive decline and radiation-induced dementia, negatively impacting patients’ long-term quality of life (QoL). This study aimed to evaluate and compare radiation dose distributions to critical brain structures across three radiotherapy techniques—3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT)—in order to assess potential neurocognitive risks and support hippocampal-sparing protocols. Materials and Methods: Ten patients previously treated with 3D-CRT were retrospectively replanned using IMRT and VMAT techniques on the Eclipse v13.3 (VARIAN) planning system. Bilateral hippocampi and temporal lobes were delineated as organs at risk (OARs) according to the RTOG atlas, and dosimetric parameters including D_max, D_mean, and D_min were recorded. V7.3 values were evaluated for hippocampal avoidance regions. Results: While IMRT and VMAT provided improved target volume coverage and reduced high-dose exposure to many standard OARs, both techniques were associated with increased D_mean and D_min to the hippocampus and temporal lobes compared to 3D-CRT. The highest D_max values to the temporal lobes were observed in 3D-CRT plans, indicating a potential risk of radionecrosis. VMAT plans showed hippocampal mean doses exceeding 10 Gy in some cases, with V7.3 > 40%, breaching established neurocognitive risk thresholds. Conclusions: These findings support the routine delineation of the hippocampus and temporal lobes as OARs in radiotherapy planning for nasopharyngeal cancer. The implementation of hippocampal-sparing strategies, particularly in IMRT and VMAT, is recommended to reduce the risk of radiation-induced cognitive toxicity and preserve long-term QoL in survivors. Full article
(This article belongs to the Special Issue Head and Neck Cancers: Modern Management)
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