 Approximately 30,000 new cases of local-regionally advanced head and neck carcinoma HNC and head and neck squamous cell carcinoma HNSCC are diagnosed each year for which surgery is either insufficient, non-curative or not feasible. For these patients, radiation therapy is the mainstay of treatment often with the use of concurrent chemotherapy andor concurrent cetuximab therapy. Radiation therapy is also commonly employed in the post-operative setting for patients with high risk features predisposing to recurrent disease. Although progress has been made, the prominent pattern of failure among these aggressively treated patients remains loco-regional failure. 