We enjoyed Johan Bussink and colleagues' review on PET-CT for response assessment andtreatment adaption in head and neck cancer; however, the authors did not comment on other functional imaging techniques that might be valuable in this patient group. Modern non-surgical treatments for head and neck squamous-cell carcinoma (HNSCC), which involve combinations of radiotherapy with chemotherapy or biotherapy, are close to the limit of acceptable toxic effects. Therapy clearly needs to be individualised, possibly either by de-escalating treatment intensity in patients who have a favourable prognosis or an early response, or by intensifying or switching treatment modality in patients who have a poor outlook. Non-invasive imaging biomarkers are ideal candidates to tailor treatment approaches, and to provide functional data that are absent from simple anatomical imaging.
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