Head and neck squamous cell carcinomas (HNSCC) constitute the sixth most common malignancy worldwide, with approximately 25–40% of the diagnosed patients older than 70 years. HNSCC patients are often frail and frequently have multiple comorbidities due to their unhealthy lifestyle, and evidence suggests that older patients may receive less aggressive and suboptimal treatment than younger patients with the same disease status. The aim of this review is to depict and summarize the evidence regarding the different strategies that can be used in the clinical management of elderly HNSCC patients. Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. This paper contains a narrative report and a critical discussion of clinical approaches in the context of elderly HNSCC.

• Thymic epithelial tumors(TETs) often require a multimodal approach, including RT. • RT dose recommendations largely derive from old data, where 2D RT was widely used. • This systematic review focused on the optimal dose for TETs with modern RT. • 5 eligible studies reporting dose response were analyzed and synthesized. • Current guidelines remain valid, this work might be an eye-opener fostering new data.

Background: Thymic epithelial tumors (TETs) are rare thoracic tumors, often requiring multimodal approaches. Surgery represents the first step of the treatment, possibly followed by adjuvant radiotherapy (RT) and, less frequently, chemotherapy. For unresectable tumors, a combination of chemotherapy and RT is often used. Currently, the optimal dose for patients undergoing radiation is not clearly defined. The available guidelines’ recommendations on RT are based on studies with a low level of evidence, where two-dimensional (2D)-RT was widely used. Methods: A systematic review of the recent literature regarding the optimal radiation dose for patients with TETs undergoing RT was carried out. It included reports using modern RT techniques such as 3D-CRT, intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT), or proton therapy. A comprehensive literature search of four databases was conducted following the PRISMA guidelines. Two investigators independently screened and reviewed the retrieved references. Reports with 54 Gy is recommended for unresectable TETs, while a dose below 52 Gy has been defined as "palliative" for recurrent TETs. Conclusions: The optimal RT dose for postoperative or primary RT in the era of modern RT did not univocally emerge. Current recommendations remain valid. Doses of 54 Gy or higher can be recommended for definitive RT only. Conversely, this overview can spark new evidence to define the optimal RT dose for each TETs category.