Computed tomography in therapy management: Tumors of the head and neck

Although malignancies of the head and neck are relatively infrequent in Europe and the Western world, they form a significant and rewarding part of the work of most departments of radiotherapy and oncology. In the South Thames metropolitan regions, for which a good cancer registry allows reliable information on cancer incidence, during 1975 only 717 of 25,125 (2.9%) patients presenting with new malignancies for treatment had tumors of the heat and neck. However, of these, 78% were treated by radiotherapy as part of their primary management, in contrast with an average of only one-third of patients with cancers in all sites receiving radiotherapy as initial treatment. At our hospital during 1980, approximately 2,700 patients were treated by radiotherapy and cytotoxic chemotherapy, of whom about 1,500 presented for the first time. Of these, 144 had malignancies in head and neck sites, 10 being pituitary tumors, which are of special interest to our department. In common with the majority of centers in the United Kingdom, and in contrast to practice in North America, radiotherapy is employed as the primary treatment modality for attempting cure, even in advanced disease, of almost all head and neck malignancies, with salvage surgery reserved for treatment failures. Such failures, when they occur, present two major problems: 1. If the failure is within the high dose planned treatment volume, this must be regarded as a radiobiological failure. 2. If the failure to control primary tumors of the head and neck occurs at the margins of the irradiated volume, this must be regarded as a failure to adequately assess the spread of the tumor at the time of initial treatment planning