Head and neck squamous cell carcinomas arise from the mucosa of the upper aerodigestive tract and is often driven by risk factors like tobacco and alcohol consumption. Most of the time patients present with locally advanced stages and the outcome is poor, despite recent advances in multi-modality treatment. The epidemiology of the disease has changed over the last decade with the introduction of a separate clinical entity; Human Papillomavirus (HPV) associated head and neck cancer. The tumorigenesis is different from that of tobacco and alcohol-driven malignancies. These tumors have a better response to treatment owing to their inherent genetic makeup and carry an excellent prognosis. The current school of thought is to reduce the long-term morbidities associated with various treatment modalities, as these patients tend to survive longer. The best management of HPV-associated oropharyngeal cancer is under active investigation.
Part of the book: Pharynx
Differentiated thyroid cancer is treated by surgery, radioiodine treatment, and Thyroid Stimulating Hormone (TSH) suppression. The role of external beam radiotherapy is mainly palliation of radio-iodine non avid metastatic lesions and in inoperable tumors. Metastasis involving weight-bearing bones and vertebral metastasis with impending spinal cord compression are primarily treated by external radiation. External Beam Radiotherapy improves loco-regional control in patients with gross residual disease after surgical resection. Patients with extra-thyroidal disease and positive margins are treated by adjuvant external beam radiotherapy, especially when the post op radio-iodine scan is negative. External beam radiotherapy is the treatment of choice for radio-iodine non avid inoperable loco-regional recurrence. SRS alone or surgery followed by SRS is the preferred treatment for solitary brain metastasis. Whole brain radiotherapy is the treatment of choice for multiple brain metastatic disease.
Part of the book: Thyroid Cancer