Table 1.

Key Points Summary

Controversies
Alterated fractionation	Hyperfractionation allows the repair of RT-induced damage in normal tissue, but tumor tissue. It has the potential to reduce late side effects, delivering a higher total dose than CRT. Hyperfractionated RT should be considered in the treatment of locally advanced HNC.
"New" toxicity	IMRT can expose head and neck structures to significant doses of radiation. New dose-volume parameters should be considered.
Prospective
Dose de-intensification	Due to proven improved outcomes, HPV-related HNC should receive less-intense RT treatment.
Proton therapy	A promising alternative to IMRT. Due to its physical properties, proton therapy assures high doses to target volume and largely spare surrounding tissues.
Immunotherapy	RT with immunotherapy can improve tumor control and reduce toxicity. Further clinical trials are needed.
DaRT	A novel method that use the decay of Radium-224 to release alpha particles into the tumor. No firm conclusions can be made because of the lack of human data.

RT, radiation therapy; CRT, chemoradiotherapy; HNC, head and neck cancer; HPV, human papilloma virus; IMRT, intensity modulated radiation therapy; DaRT, diffusing alpha emitters radiation therapy.