Timing of Radiation Therapy in Head and Neck Cancer

Postoperative Radiation Therapy Timing

• The American Society of Clinical Oncology recommends keeping the total time from surgery to completion of radiotherapy as short as possible, ideally less than 6 weeks for patients with high-risk features 1, 2

Pre-Radiation Dental Assessment

• The American Dental Association recommends dental assessment by a dentist prior to therapeutic-intent radiation therapy, including comprehensive dental, periodontal, and oral radiographic examination 3, 4
• Teeth with poor prognosis within the radiation field should be removed prior to RT, as recommended by the American Society of Clinical Oncology 3, 4

Definitive Radiation Therapy Timing

• The National Comprehensive Cancer Network recommends that surgery should not be delayed beyond 8 weeks from diagnosis for early T1-T2 N0 oral cancer, and immediate radiotherapy should be considered if surgery cannot occur within 8 weeks 5
• For early T1 N0 laryngeal cancer, radiotherapy should be recommended immediately instead of surgery if a delay of 4-8 weeks is anticipated, as recommended by the American Society of Clinical Oncology 5
• For advanced head and neck cancer, surgery should not be delayed beyond 4 weeks of diagnosis, and alternative treatment such as radiotherapy or chemoradiotherapy should be given immediately if surgery cannot occur within 4 weeks, as recommended by the European Society for Medical Oncology 5

Concurrent Chemoradiation Timing Considerations

• The American Society of Clinical Oncology recommends delivering at least 1000 cGy/week when using altered fractionation schedules 1
• The standard regimen is cisplatin 100 mg/m² every 3 weeks with conventional fractionation RT, as recommended by the National Comprehensive Cancer Network 6, 2