Strategies for Non-Resectable Head and Neck Cancer

Abstract

Treatment of unresectable, locally advanced head and neck cancer consists of many different options, all of them based on radiotherapy. The main variable is represented by chemotherapy, i.e., the way in which chemotherapy is combined with radiation. More recently, the combination of cetuximab and radiotherapy emerged as a new treatment opportunity and induction chemotherapy, with the combination of docetaxel, cisplatin, and 5-fluoruracil, gained a renewed interest. Concurrent chemoradiation is based on the most robust evidence and is regarded as the leading standard of care for unresectable locally advanced head and neck cancer. Unfortunately, chemoradiation is hampered by severe toxicity and patients must be selected carefully before treatment. The experience of the staff (medical oncologists, radiation oncologists, and nurses), and in particular its familiarity with toxicity management, as well the structural facilities, play an important role in the final outcome. When the patient is unfit for chemoradiation, or when experienced staff or adequate structures are unavailable, induction chemotherapy, cetuximab and radiotherapy, or radiotherapy alone are all evidence-based alternative options. The choice among them will be based on the clinical condition of the patient, the physician's experience, and the patient's preference. Whatever is the treatment of choice, it is important to involve a multidisciplinary staff in the management of these patients. Indeed, also unresectable patients may require supportive surgical interventions before or during treatment, or removal of residual disease after treatment.

Efficacy and safety of a cisplatin and paclitaxel induction regimen followed by chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma

“…Thereby, the resectability status was used in this phase 2 trial to allow different strategies during the treatment, including salvage surgery for resectable tumors that failed with induction chemotherapy. However, a large fraction of resectable tumors can be treated nonsurgically (CRT with or without induction chemotherapy) in an effort to preserve organ anatomy and function, and some patients with unresectable disease might become candidates for salvage surgery …”

Systematic review and meta‐analysis of the impact of dosimetry to dysphagia and aspiration related structures

“…It can increase both morbidity and mortality for people in this population. 1 Reported factors that can influence swallow function include age, 2,3 comorbidities, 4,5 gender, 2 cancer diagnostic factors such as the TNM classification system, 2,4,6 location of the cancer, 2,6 depression, 7 treatment factors such as modalities of treatment, 8 and involvement of a multidisciplinary team (MDT). 9 Technology has allowed new options in radiotherapy methodology, which has brought about improvements in both the quality of life of the patients 10 as well as demonstrating promising survival rates; although, it has been noted that longer follow-up of patients in research studies is required.…”

Radiation Treatment of Unresectable Laryngeal Cancer

“…Считается, что он увеличивает вероятность рецидива забо-левания -от 0,6 до 2 % на каждый день перерыва свыше трех-пяти дней [15]. Тем не менее одними из ключевых факторов развития острых и поздних лучевых реакций являются объем опухолевого поражения и нерезектабельность новообразо-вания [9,12,14]. Как следствие, использование сплит-курсов при ЛТ нерезектабельных опухолей органов головы и шеи является допустимой ме-тодикой, позволяющей улучшить переносимость лечения и снизить вероятность развития тяжелых осложнений, а также подвести большую дозу на опухоль [8,13,16].…”