Functional imaging to predict treatment response after (chemo) radiotherapy of head and neck squamous cell carcinoma

Head and neck squamous cell carcinoma (HNSCC) refers to malignant tumors that arise in the upper aerodigestive tract including oral cavity, pharynx, larynx, nasal cavity and paranasal sinuses. About one third of the patients present with early stage disease (stage I and II), while two-third presents with advanced disease (stage III and IV). In the past the majority of patients with advanced stage disease were treated with a combination of surgery and radiotherapy, often with the costs of functional and cosmetic morbidity, inducing a diminished quality of life. Irresectable (technically inoperable) HNSCC was treated by radiotherapy with or without chemotherapy. Nowadays, in an attempt to decrease the morbidity non-surgical treatments are increasingly applied, also to resectable HNSCC, with considerable complete remission rates. It appeared that intensified radiotherapy schemes and combinations of chemotherapy and radiotherapy all contribute to an increased remission rate. In advanced HNSCC locoregional control rates about 50% are reported. However, also non-surgical treatment is not without acute and long-term side effects, leading to compromised quality of life.