Precision radiation oncology in head and neck cancer: beyond physical precision - a narrative review

Radiotherapy is an integral part of the management of head and neck cancers, both in radical and adjuvant settings. Traditionally, similar radiation dose and fractionation schedules have been used based on tumor stage with variable outcomes indicating “one size does not fit all”. In the era of precision medicine, though we have achieved physical precision with technological advancements, we have yet to attain biologic precision. In the current review, we have highlighted the different aspects of precision oncology such as hypoxia targeting, radiomics and radiogenomics, radiobiologic targeting, and big data. The review also discusses various potential therapeutic targets and approaches in head and neck cancer management that might help to increase radiosensitization, which in turn increase survival, and quality of life. This can be incorporated into the armamentarium of radiation oncology in all the phases of radiation planning, from diagnosis to treatment to the prognosis and management of long-term side effects. Biologic precision can be applied in the clinic to provide individualized, personalized treatment in the future.