Contents

## **Preface XI**



## Preface

Head and neck cancers comprise of tumours arising in the following anatomical locations: oral cavity, pharynx (nasopharynx, oropharynx, hypopharynx), larynx, paranasal sinuses, nasal cavity and salivary glands. The predominant type consists of squamous cell carcino‐ mas (95%) whilst the remaining are adenocarcinomas or melanomas.

According to the latest Globocan report issued by the International Agency for research on Cancer, the estimated incidence of head and neck cancer (HNC) in 2012 among men repre‐ sents 7% of all cancers, while in women is 2.6% [1]. While the incidence of head and neck cancers caused by known risk factors such as tobacco smoking and alcohol consumption has lately decreased [2], a relatively new entity of head and neck squamous cell carcinoma, mostly located in the oropharynx was shown to be on the rise and was attributed to the human papil‐ lomavirus (HPV) [3]. This distinct entity of head and neck cancer holds different biological characteristics from the non-HPV tumours and responds differently to therapy [3,4]. New treatment challenges are therefore generated that need solutions in the near future.

Conventional treatment techniques such as surgery and radio-chemotherapy have not im‐ proved significantly the overall 5-year survival of this disease over the past thirty years. The high mortality rate is due to the fact that most head and neck cancers are diagnosed at ad‐ vanced stages of the disease. Additionally, given the anatomical location of these tumours, treatment often leads to long-term side effects, which can have a significant impact on the quality of life. Early diagnosis therefore plays a key role in increasing the therapeutic ratio and improving patient survival and quality of life.

As for several other tumour types, radiobiology continues to shape the treatment of head and neck cancers. The original four Rs of radiotherapy (i.e. repair, repopulation, reoxygena‐ tion and redistribution along the cell cycle) have been promoted to six Rs by the inclusion of radioresistance and remote effects. New developments related to cancer stem cells and their interaction with the hypoxic environment, as well as the higher radiosensitivity of HPV-pos‐ itive HNC due to their compromised repair capacity are important elements for new treat‐ ment designs.

While the management of head and neck cancer is evolving, there are still several challenges and unanswered questions that need solutions. Further efforts are needed to resolve clinical concerns such as:

• Tumour repopulation during treatment and the role of cancer stem cells in head and neck tumour recurrence;

• Quantitative assessment of radiobiological hypoxia in head and neck tumours and meth‐ ods to overcome hypoxia-driven radioresistance;


*Contemporary Issues in Head and Neck Cancer Management* is a small compilation of some topical aspects regarding head and neck cancer treatment, including the etiology of HPVpositive oropharyngeal cancers and risk factors in the young population, the challenge of surgical margin definition and the perennial problem of systemic treatment due to distant metastases. Radiobiological aspects are also covered through the "Rs" of radiotherapy, with a couple of chapters being dedicated to radioresistance and tumour microenvironment. This book comes as an addition to the existing literature that aims to tackle this radiobiologically challenging tumour.

I would like to thank all authors for their hard work and great contributions to this volume of *Contemporary Issues in Head and Neck Cancer Management*

**Prof. Loredana G. Marcu**

Faculty of Science, University of Oradea, Romania School of Chemistry and Physics, University of Adelaide, SA, Australia

#### **References**

[1] Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11, 2013, Lyon, France: International Agency for Research on Cancer. Available from http://globocan.iarc.fr.

[2] Chaturvedi AK, Engels EA, Anderson WF, Gillison ML. Incidence trends for human pap‐ illomavirus-related and -unrelated oral squamous cell carcinomas in the United States. J Clin Oncol 2008;26(4):612-9.

[3] Ang KK, Sturgis EM. Human papillomavirus as a marker of the natural history and re‐ sponse to therapy of head and neck squamous cell carcinoma. Semin Radiat Oncol 2012;22(2):128-42.

[4] Urban D, Corry J, Rischin D. What is the best treatment for patients with human papillo‐ mavirus-positive and –negative oropharyngeal cancer? Cancer 2014;120(10):1462-70.

**Radiobiology and Tumour Microenvironment**

• Treatment individualisation based on tumour kinetics and dynamics;

• Treatment directions for HPV positive oropharyngeal cancer and dose de-escalation;

*Contemporary Issues in Head and Neck Cancer Management* is a small compilation of some topical aspects regarding head and neck cancer treatment, including the etiology of HPVpositive oropharyngeal cancers and risk factors in the young population, the challenge of surgical margin definition and the perennial problem of systemic treatment due to distant metastases. Radiobiological aspects are also covered through the "Rs" of radiotherapy, with a couple of chapters being dedicated to radioresistance and tumour microenvironment. This book comes as an addition to the existing literature that aims to tackle this radiobiologically

I would like to thank all authors for their hard work and great contributions to this volume

[1] Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11, 2013, Lyon, France: International Agency for Research on Cancer. Available from http://globocan.iarc.fr. [2] Chaturvedi AK, Engels EA, Anderson WF, Gillison ML. Incidence trends for human pap‐ illomavirus-related and -unrelated oral squamous cell carcinomas in the United States. J Clin

[3] Ang KK, Sturgis EM. Human papillomavirus as a marker of the natural history and re‐ sponse to therapy of head and neck squamous cell carcinoma. Semin Radiat Oncol

[4] Urban D, Corry J, Rischin D. What is the best treatment for patients with human papillo‐

mavirus-positive and –negative oropharyngeal cancer? Cancer 2014;120(10):1462-70.

**Prof. Loredana G. Marcu**

SA, Australia

Faculty of Science, University of Oradea, Romania

School of Chemistry and Physics, University of Adelaide,

• Distant metastases and systemic treatment approaches; • The role of targeted therapy in head and neck cancer;

• Reduction of treatment-related normal tissue complications.

of *Contemporary Issues in Head and Neck Cancer Management*

challenging tumour.

VIII Preface

**References**

Oncol 2008;26(4):612-9.

2012;22(2):128-42.
