Advances in radiation therapy of head and neck cancer.

Head and neck cancer is the fifth most common cancer in the USA. Although there have been major improvements in surgical and radiation techniques, the overall survival has not changed significantly in the last decade. The major changes occurring in recent years have been in the ability to preserve organs and to improve quality of life. The advances in radiation therapy include 3D conformal radiotherapy, intensity-modulated radiotherapy and, more recently, imaging-guided radiotherapy. In advanced head and neck cancer the addition of chemotherapy to radiation has concomitantly improved survival and facilitated higher rates of organ preservation. Clinical trials are needed to develop better strategies customized to subgroups defined by individual biological risk and imaging findings.