Issues and implementation of postoperative radiotherapy after flap reconstructive surgery in head and neck cancers

The management of head and neck cancers is multidisciplinary, often relying on the use of combined treatments to maximize the chances of cure. Combined treatments are however also responsible for cumulative side effects. The aim of reconstructive surgery with a fl ap is to restore a function lost with the loss of substance from the tumor resection. However, changes in reconstructive surgery have impact of postoperative radiotherapy planning. The optimization of imaging protocols for radiotherapy planning should make it possible to identify postoperative changes and to distinguish fl aps from surrounding native tissues to delineate the fl aps and document the spontaneous evolution of these fl aps or dose -effect relationships in case of radiotherapy. Such changes include atrophy, fi brosis of soft tissue fl aps and osteoradionecrosis of bone fl aps. Radiotherapy optimization also involves standardization of the de fi nition of target volumes in situations where a fl ap is present, a situation that is increasingly common in routine care. This evolution of practice, beyond the essential multidisciplinary consultation meetings de fi ning treatment indications, requires a close radio surgical collaboration with respect to technical aspects of the two disciplines. Doing so, anticipation of relapse and toxicity pro fi les could possibly lead to propose strategies for personalized de-escalation of multimodal treatments through interdisciplinary trials.