ABSTRACT
Head and neck squamous cell carcinoma (HNSCC), perhaps more than other cancer types, poses the problem of the benefit-risk balance. Indeed, these tumours are radio-curable, but at very high doses in an extremely functional anatomical environment, where early or late toxicity can have devastating effects on the quality of life (QOL). Proton therapy (PT) has been applied to treatment of head and neck (H&N) tumours that are not HNSCC. This chapter shows that the biologically guided radiation therapy (BGRT) based on normal tissue complication probability (NTCP) calculations and comparisons is a reality. NTCP models contribute to a paradigm shift in the practice of evidence-based medicine. While NTCP modelling is still very specialised and mastered by a few teams, the background work of conventional prospective trials is running. This is absolutely complementary to the model-based approach and rather well advanced in the field of PT applied to HNSCCs.
