Radiotherapy is utilized in the treatment of various cancers of the central nervous system and head and neck. Given the high concentration of organs-at-risk in this region, care must be exercised to minimize the dose delivered to these structures. Studies have shown that excessive radiation exposure can adversely impact the eyes, potentially resulting in the loss of their function. For instance, radiation doses greater than 50 Gy have been shown to increase the incidence of retinopathy, and radiation doses as low as 0.5 Gy have been shown to induce cataract formation. In this review, we discuss the ocular complications of radiotherapy used in the treatment of cancers of the central nervous system and head and neck. We then transition to potential strategies to spare the eyes during radiotherapy in an effort to reduce the rates and severity of ocular complications and preserve vision.

Raynaud’s phenomenon of the tongue after radiation therapy with or without chemotherapy is an exceedingly rare complication. Symptoms are similar to Raynaud’s disease of other sites and involve pallor and discomfort on exposure to cold temperatures that resolve with rewarming. Presentation occurs approximately 18-24 months after radiotherapy on average and can usually be managed effectively with lifestyle modification and pharmacotherapy. Here, we present a case of lingual Raynaud’s following surgery and adjuvant radiation therapy in a patient with squamous cell carcinoma of the oral cavity.

Introduction: Non-muscle-invasive bladder cancer (NMIBC) represents approximately 78% of newly diagnosed bladder cancers and is characterized by high recurrence rates and variable progression risk. While transurethral resection of bladder tumor (TURBT) followed by intravesical therapy remains standard management, optimal treatment of high-risk and Bacillus Calmette-Guerin (BCG)-unresponsive disease remains controversial. Radiotherapy (RT), particularly in combination with chemotherapy, has been explored as a bladder-preserving alternative. Material and Methods: We conducted a narrative review of published literature evaluating the role of definitive RT in high-risk NMIBC, with emphasis on T1 disease. Retrospective series, prospective trials, meta-analyses, and contemporary guideline recommendations were examined. For each included study, we extracted data on the extent of TURBT (maximal vs. incomplete/non-specified), use and type of concurrent chemotherapy, radiotherapy technique (3D-conformal, IMRT, or proton), treatment volume (bladder only vs. whole pelvis), and dose/fractionation schedule. Results: Early studies evaluating RT alone demonstrated modest complete response rates. More recent approaches incorporating maximal TURBT followed by concurrent chemoradiotherapy report improved outcomes, with complete response rates of approximately 80–88% and 5-year overall survival comparable to surgical series. The phase II NRG/RTOG 0926 trial in recurrent high-risk T1 disease after intravesical therapy failure demonstrated an 81% complete response rate and favorable bladder preservation outcomes. Meta-analytic data suggest 5-year recurrence-free survival around 54% and overall survival near 70%, although evidence remains limited and largely non-randomized. Advances in image-guided and hypofractionated RT may further improve therapeutic outcomes while limiting toxicity. Conclusions: while definitive chemoradiotherapy is a promising option for selected patients, it remains investigational and should be considered only in those who are unfit for or decline radical cystectomy. Prospective randomized studies are needed to better define its role in contemporary management.

Introduction: Head and neck squamous cell carcinomas (HNSCCs) are among the most common cancers worldwide and continue to carry substantial morbidity and mortality despite advances in surgery, radiation therapy (RT), and systemic therapy. Treatment varies according to disease stage, clinical setting, and prior therapy. The immunologically active tumor microenvironment of HNSCC and expression of immune-regulatory pathways have made immunotherapy an important area of therapeutic development. Methods: This is a narrative review of the established and emerging immunotherapeutic strategies for HNSCC, their clinical applications, mechanisms of resistance, and future directions. We used relevant search terms in PubMed to examine the available literature. Discussion and Conclusions: We discuss several immunotherapeutic agents, including PD-1, PD-L1 and CTLA-4 inhibitors, as well as emerging immune checkpoint targets such as LAG-3, TIGIT, TIM-3 and VISTA. We also consider the importance of HPV status in prognosis and treatment response. The role of immunotherapy is considered across disease stages and treatment settings, with particular emphasis on recurrent or metastatic HNSCC and locally advanced HNSCC in the perioperative setting, for which PD-1 inhibitors have demonstrated the clearest clinical benefit and have become an important component of standard therapy. We also review the expanding role of neoadjuvant and adjuvant immunotherapy, as well as combinations with RT, for which efficacy remains under investigation or has been inconsistent across clinical trials. In addition, we examine mechanisms of primary and acquired resistance related to tumor biology and molecular mutations. Finally, we highlight emerging therapeutic approaches, including chimeric antigen receptor T-cell therapy, therapeutic cancer vaccines, and combinations of immunotherapy with proton beam therapy. Together, these developments illustrate the rapidly expanding role of immunotherapy across HNSCC treatment and identify areas in which further investigation may expand therapeutic options and improve outcomes.