Precision Medicine and Low-Dose Radiation Are Transforming Head and Neck Cancer Care

Time of India

20-05-2025

New Delhi: Globally, over 900,000 new cases of head and neck cancer are diagnosed annually. The treatment landscape for head and neck cancers (HNCs) has undergone a dramatic shift over the past two decades, with
precision medicine
, immunotherapy, and functional preservation leading the way.
Dr Jatin P. Shah, Head and Neck Surgeon at Memorial Sloan Kettering Cancer Center (MSK), shares how these advances are transforming care, improving outcomes, and reducing toxicity—especially relevant for India, where HNCs remain a significant public health challenge.
'The most important development in recent years is the ability to identify the genetic mutations and fusions that drive these cancers,' says Dr Shah. Through molecular profiling, clinicians can now tailor therapies to a tumor's genetic fingerprint—a hallmark of precision oncology.
MSK's proprietary IMPACT assay exemplifies this approach, analyzing hundreds of cancer-related genes to identify targetable mutations. 'This is particularly promising for patients with rare or treatment-resistant head and neck cancers,' he explains, 'as it offers new hope when conventional therapies fail.'
However, while targeted therapies are powerful, only a limited number of mutations are currently druggable. Immunotherapy, on the other hand, has seen broader applications. 'It's now routinely used in recurrent, metastatic, and even some advanced-stage patients before surgery,' Dr. Shah notes.
HPV-Positive Cancers: High Cure Rates, Lower Side Effects
One of the most notable breakthroughs has been the recognition of HPV-positive oropharyngeal cancers, which respond remarkably well to treatment. Globally, HPV-related head and neck cancers are on the rise, particularly in younger, non-smoking individuals.
HPV accounts for up to 70 per cent of oropharyngeal cancers in some populations, and these cancers tend to have better outcomes.
According to Dr Shah, the challenge now is to maintain high cure rates while minimizing long-term side effects. MSK is leading a promising clinical trial using low-dose radiation (30 Gy) for HPV-positive patients.
'Early results show excellent tumor control with far fewer side effects compared to traditional high-dose radiation,' he reports. This marks a potential paradigm shift in how these cancers are treated.
Radiation Therapy: No Longer 'One Size Fits All'
Radiation therapy has historically been viewed as a blunt tool—powerful but often associated with severe side effects. That perception is changing.
'One of the biggest misconceptions is that all patients require the same high radiation dose,' Dr. Shah says. 'Today, radiation is personalized, just like surgery.'
Advances in imaging, diagnostics, and tumor biology now allow clinicians to customize doses and target areas, reducing damage to healthy tissues.
Dr Shah highlights emerging treatments for aggressive head and neck cancers, including sinonasal carcinomas and salivary gland tumors. 'We're testing chemo-immunotherapy combinations to either avoid or limit surgery, preserving function and appearance.'
For rare salivary gland tumors like salivary duct carcinoma, researchers are targeting molecular markers such as the androgen receptor and HER2, similar to therapies used in prostate and breast cancer.
'These targeted treatments represent a leap forward in personalizing care for even the rarest tumor types,' he adds.
India's Head and Neck Cancer Burden: Prevention is Key
India bears one of the highest burdens of head and neck cancers globally, largely due to the widespread use of tobacco products, including gutka and pan masala. India accounts for nearly 30 per cent of global cases of oral cancer, with tobacco use being the leading cause.
'Head and neck cancer is largely preventable,' Dr. Shah emphasizes. 'Avoiding tobacco—both smoked and chewed—is one of the most effective strategies.' He urges healthcare providers in India to promote early detection, especially for symptoms like persistent mouth ulcers, voice changes, or difficulty swallowing.
With modern medicine advancing rapidly, the focus in head and neck oncology is increasingly on individualized care—delivering the most effective treatments while preserving quality of life.