Combined Modality Therapy for Thoracic and head and Neck Cancers: A Review of Updated Literature Based on a Consensus Meeting

Abstract

Purpose: Combined modality therapy is a mainstay option for thoracic malignancies and head and neck cancers. The integration of different strategies is based on the multidisciplinary approach of modern clinical oncology. Radiation oncologists have to be educated, trained, and updated to provide state-of-the-art care to cancer patients and thus educational meetings are crucial. Methods: The Italian Association of Radiation Oncology Young Members Working Group (AIRO Giovani) organized its 8 th national meeting, focused on combination therapy in lung, esophageal, and head and neck cancer (with a specific focus on larynx-preservation strategies for larynx/hypopharynx tumors), involving young professionals working in Italy. The meeting was addressed to young radiation oncologists, presenting state-of-the-art knowledge, based on the latest evidence in this field. We performed a review of the current literature based on the highlights of the Congress. Results: The multimodality approach of head and neck and thoracic malignancies includes surgery, chemotherapy, and radiotherapy, but also has to take into account new information and data coming from basic and translational research and including molecular biology, genetics, and immunology. All these aspects are crucial for the treatment of non-small-cell lung cancer and esophageal, esophagogastric junction, and larynx/hypopharynx malignancies. The integration of different treatments in the clinical decision-making process to combine therapies is crucial. Conclusions: Combination therapy has proved to be a consolidated approach in these specific oncologic settings, highlighting the importance of multimodality management in modern clinical oncology. Dedicated meetings on specific topics are helpful to improve knowledge and skills of young professionals in radiation oncology.

Prospective assessment of oral mucositis and its impact on quality of life and patient-reported outcomes during radiotherapy for head and neck cancer

“…Patients affected with HNC are frequently treated with multimodality treatment and thus can develop a wide range of acute and late side effects and long-term sequelae [3,[15][16][17][18]. The occurrence of OM in HNC patients treated with RT and/or CT is an extremely frequent finding with consistent clinical meaningfulness [7].…”

“…Combined modality treatment including RT and chemotherapy (CT) and/or bio-therapy is a well-established option providing a survival advantage over radiation alone [3,4]. Oral mucositis (OM) is a frequent finding in HNC patients undergoing RT and the concurrent administration of CT, for example with agents having a radiosensitizing action such as cisplatin (CDDP), may enhance the damage to the mucosal layer, impairing the mechanism of sublethal damage repair and, hence, increasing the likelihood to develop this side effect [5,6].…”

Radiotherapy treatment strategies for squamous cell carcinoma of the cervical oesophagus: moving toward better outcomes

“…Nevertheless, it gives an important suggestion about the benefit in terms of survival when employing highly conformal dose-escalated RT and ENI (delivered with IMRT) in association to concurrent DDP compared to conventional techniques for CEC patients. Yet, advances in early diagnosis and mindful integration of RT with chemotherapy (including novel agents) and radical surgery remain strongly demanded to substantially improve clinical results in this subset of patients, which remain poor in general (8,9).…”

Pre-operative treatments for adenocarcinoma of the lower oesophagus and gastro-oesophageal junction: a review of the current evidence from randomized trials

“…No randomized clinical trials have specifically selected this subset of patients [2]. Clinical data can be derived from studies addressed to both oesophageal and gastric cancer, including either squamous cell carcinoma or adenocarcinoma, and hence the evidence is not robust and definitive conclusions are hard to be drawn [1][2][3]. In general, surgery has been traditionally considered the standard therapeutic option with definitive intent for patients affected with oesophageal carcinoma [4].…”

“…Tumours of the GEJ are defined as those arising within 5 cm (above and below) of the GEJ and have adenocarcinoma histology as predominant feature [2]. The most appropriate treatment approach for lower oesophageal and GEJ tumours is still under debate [3]. No randomized clinical trials have specifically selected this subset of patients [2].…”