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Squamous cell head and neck cancer (SCHNC) is the seventh most common cancer worldwide. Most of SCHNC are locally advanced at diagnosis and are treated with combination of surgery and/or radiotherapy with chemotherapy. In spite of aggressive treatment, many patients relapse within the 3 years following the diagnosis. Those whose tumor cannot be resected or reirradiated are treated with a systemic treatment mostly in a palliative setting. They are identified as recurrent and/or metastatic SCHNC (R/MSCHNC) patients. First-line treatment of R/M-SCHNC historically consisted of cytotoxic agents such as methotrexate, bleomycin, or platinum-based protocols until targeted biological therapies were introduced in the 2000's. The recent years witnessed a shift in systemic treatment toward the use of monoclonal antibodies and tyrosine kinase inhibitors, largely based on recent understanding of the role of immune dysfunction in SCHNC. Our review focuses on recent developments of molecular-targeted and immunotherapies in the treatment SCHNC, mostly focusing on R/M-SCHNC. It also highlights ongoing trials and discusses some promising novel targets in HNC, as well as clinical trial design challenges. [ABSTRACT FROM AUTHOR]

Radiation therapy (RT) is an important treatment modality in head and neck cancer (HNC) irrespective of stage, histology, and location of the primary tumor in both curative and palliative setting, with or without other treatment modalities such as surgery or chemotherapy. Based on advances with better imaging and introduction of sophisticated software for treatment and planning systems, radiation oncology of HNC witnessed major advantages resulting in both improved local control and better sparing of organs at risk. From computed tomography to magnetic resonance imaging and introduction of positron emission tomography with various radiotracers it became possible not only to diagnose and stage HNC with more confidence but also to introduce these technologies in RT treatment planning, and to use it during the RT course for the evaluation of response and additionally sculpture RT fields. Furthermore, it became possible to predict outcome based on anatomic and metabolic changes in HNC. Community of radiation oncologists successfully adopted transition from two-dimensional to three-dimensional RT and then to intensity modulated RT, as well as stereotactic radiotherapy (either single- or multi-fraction) regimens. There is renewed interest in heavy particles with both neutrons, carbon-ions and protons, the latter two being used more frequently in the recent years. This review article summarizes the most important accepts of novel RT technologies in HNC. [ABSTRACT FROM AUTHOR]

Management of patients with recurrent head and neck cancer remains a challenge for the surgeon as well as the treating radiation oncologist. Even in the era of modern radiotherapy, the rate of severe toxicity remains high with unsatisfactory treatment results. Intensity‐modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and heavy‐ion irradiation have all emerged as highly conformal and precise techniques that offer many radiobiological advantages in various clinical situations. Although re‐irradiation is now widespread in clinical practice, little is known about the differences in treatment response and toxicity using diverse re‐irradiation techniques. In this review, we provide a comprehensive overview of the role of radiation therapy in recurrent or second primary head and neck cancer including patient selection, therapeutic outcome, and risk using different re‐irradiation techniques. Critical review of published evidence on IMRT, SBRT, and heavy‐ion full‐dose re‐irradiation is presented including data on locoregional control, overall survival, and toxicity. [ABSTRACT FROM AUTHOR]

Although conventional fractionated (CF) radiotherapy (RT) became the most common non-surgical approach delivering 66-70 Gy in 33-35 daily fractions (fx) in 6.5-7 weeks several decades ago due to a good local control (LC) with low normal tissue complication rates, recent decades also brought altered fractionated RT regimens based on better understanding of radiobiology. Of these, split course RT is largely abandoned due to inferior results caused by the treatment gap, which led to inferior local control rates and consequently survival. Hyperfractionated (Hfx) RT and various forms of accelerated (Acc) RT had consistently shown improvement in the treatment outcome, given either alone or with concurrent chemotherapy (CHT). Hfx RT was most consistently superior to CF and frequently to Acc RT, while moderate Acc RT also holds promise to be used more often in daily clinical practice. The use of Hfx RT may face the challenge of applicability in busy radiotherapy departments around the world despite unequivocally having been proven as superior regarding both local/regional tumor control and overall survival. With concurrent CHT, although results favor it, risks of accompanying toxicity rise and should be considered when planning such intensified treatment approach. [ABSTRACT FROM AUTHOR]

Meta-analyses of chemotherapy in Head and Neck Cancer (MAC-HNC) showed that adding chemotherapy (CHT) to locoregional treatment improves the treatment outcome. However, it was observed only with concurrent administration of radiotherapy (RT) and CHT. Among many drugs used in this setting, cisplatin (CDDP) has most consistently been used as a single-agent with radical RT. The two most common administrations of CDDP included 100 mg/sqm every three weeks and 40 mg/sqm weekly, both during the course of RT. While a direct comparison of the two modes of CDDP administration in the definitive treatment of locally advanced squamous cell (SQC) HNC is basically lacking, recent summary brought somewhat conflicting results. Questions largely unexplored is the total CDDP dose deemed necessary when administered concurrently with radical RT. Subset analyses from various prospective randomized trials and meta-analyses seem to indicate that one may not need a total CDDP dose of significantly higher than 200 mg/sqm if at all higher than that, irrespective of the type of RT administered and seemingly unnecessary in HPV+ oropharyngeal cancer patients. Due to presumably lower but still effective threshold level of total CDDP given with RT may depend on other factors, such as frequency of CDDP administration or RT fractionation pattern and be closely interrelated with anticipated toxicity, researchers continue with their quest to find optimal approach in this setting. Large clinical trials should detect small differences between treatment options in an era when "old" but effective drugs still dominate the research arena of SQC HNC. [ABSTRACT FROM AUTHOR]

The last three decades provided new insights into the discovery of the entity related to several strains of human papillomavirus (HPV). The viral cause of HPV, primarily found in the oropharynx, was officially recognized by the World Health Organization in 2007. While epidemiologic studies around the world showed an increased incidence of HPV-related heads and neck cancers (HNC), they also established a photo robot of a typical person suffering from HPV: younger white man, suffering from a nonkeratinized type of squamous cell carcinoma, rarely being seen as heavy smoker and/or drinker. The patient with specific sexual behavior pattern usually carried low T and high N burden, HPV16 being detected in the vast majority of HPV+ tumors, mostly in the oropharynx. It was also recognized that HPV-related cancers seem to have a better prognosis than their HPV-unrelated counterparts. This observation served as an important starting point for clinical studies aiming first to identify different risk groups and then to design various de-intensification treatment strategies which aimed to maintain high success rate with e.g. lower radiotherapy and/or chemotherapy doses while decreasing side effects such deintensified treatment strategies should bring. This review summarizes the most important aspects of HPV-related HNC. [ABSTRACT FROM AUTHOR]

Here we present a summary of existing evidence from meta-analyses and systematic reviews in the setting of locally advanced, inoperable squamous cell cancer of the head and neck, treated with radical radiotherapy and concurrent cisplatin therapy either weekly or every 3 weeks. Taken together, the data seem to indicate that there is no difference in major outcomes, including toxicity. However, caution in the interpretation of the data should be exercised due to poor quality of original studies, none of which was a prospective randomized phase III trial. Practicing clinicians should continue using their best judgment about the most appropriate treatment option in this setting, taking into account both the existing evidence and also various patient and tumor characteristics. [ABSTRACT FROM AUTHOR]

The spread of dirofilariosis, as a newly emerging zoonosis, due to global changes has been documented in several Central European countries. In Slovakia, the first autochthonous case of dirofilariosis was recorded in dogs in 2005. The first case of human subcutaneous dirofilariosis caused by Dirofilaria repens was diagnosed in a 60- year-old patient from an area of western Slovakia. We report another case of dirofilariosis in a 37-year-old woman living in the same area of south-western Slovakia. The infection manifested as a painful, inflamed nodule on the back of the left hand, containing an adult parasite. Morphological analysis aroused suspicion of the presence of a filarial worm belonging to the genus Dirofilaria. Subsequent PCR analysis of the DNA identified the parasite as Dirofilaria repens. After removal of the parasite, the subcutaneous nodule completely resolved and the patient was successfully cured.