The complexity of head and neck cancers (HNC) mandates a multidisciplinary approach and radiation therapy (RT) plays a critical role in the optimal management of patients with HNC, either as frontline or adjuvant treatment postoperatively. The advent of both definitive and post-operative RT has significantly improved the outcomes of patients with HNC. Herein, we discuss the role of postoperative RT in different subtypes of HNC, its side effects, and the importance of surveillance. The treatment regions discussed in this paper are the oral cavity, nasopharynx, paranasal sinus cavity, oropharynx, larynx and hypopharynx. Multiple studies that demonstrate the importance of definitive and/or postoperative RT, which led to an improved outlook of survival for HNC patients will be discussed.

A 26-year-old male presented with shortness of breath, cough, and chest pain with a 2-year history of diffuse skin lesions. He underwent evaluation with computed tomography (CT) and follow-up positron emission tomography (PET)/CT imaging, identifying a 17.3 Â 8.0 cm anterior mediastinal mass (Fig. 1A). Biopsy identified a diffuse large B-cell lymphoma, positive for CD45, CD20, and CD23 with a Ki-67 of 35%. There was partial positivity of BC-6 and CD30. The biopsy was negative for CD10, CD15, C-MYC, CD5, CD13, and EBER. Because of its location, it was classified as a primary mediastinal B-cell lymphoma.The patient initiated therapy with dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-EPOCH). He had resolution of his symptoms, including the skin lesions, after completion of 2 cycles of R-EPOCH. An interval PET/CT obtained at this time showed 8 cm of residual disease with a Deauville 3 response (Fig. 1B). The patient had a follow-up PET/CT 2 months after completion of 6 cycles of R-EPOCH therapy that showed 4.2 cm of residual disease and persistent Deauville 3 response (Fig. 1C).