Amifostine given before each fraction of radiotherapy over 6 weeks has no cumulative toxicity, was well tolerated and may reduce treatment induced oral mucositis. No tumor protective effect was observed.

Therapy for squamous cell carcinoma of head and neck relies on surgery, radiotherapy and chemotherapy, mostly a combination thereof. In patients treated with curative intent, the intensity of therapy is adapted to the supposed prognosis and should be defined upon prognostic factors. Besides classical prognostic parameters, T, N and M stage, the presence of extranodal growth (extracapsular spread, ECS), tumor volume, lymph node burden, extent of tumor necrosis, histologic grading, but also type of treatment were determined in consideration of prognosis. The p53 status does not correlate with prognosis in most investigations. The tumor hypoxia seems to be of prognostic value, and strategies to overcome the adverse effect are currently investigated. Not all factors are relevant for all types of treatment. Besides ECS, these new factors so far have rarely been used to stratify prospective combined modality treatment according to the risk of locoregional and distant failure.

A significant improvement in reposition accuracy using an additional, individually formed jaw fixation can be acquired. The variability of positioning can be reduced especially in the z-direction. A further reduction of the safety margin around the target volume--especially in benign tumors--is possible by improved fixation technique.

A statistically significant effect of the use of CAD could not been detected dependent on the radiological experience or the CAD experience. The effect of CAD on radiologists is still subtle despite the highly sensitive CAD performance due to the high number of false positive prompts and thus does not reach statistical significance. Sizes given by CAD prompts correlate significantly with the real sizes of malignant lesions.

No abstract