ACR appropriateness criteria (R) adjuvant therapy for resected squamous cell carcinoma of the head and neck
Duke University, Durham, NC, United States. Oral Oncology
(Impact Factor: 3.61).
07/2011; 47(7):554-9. DOI: 10.1016/j.oraloncology.2011.05.002
Locoregional recurrence following surgical resection alone for stage III/IV head and neck cancer is common. Adjuvant radiotherapy has been shown to improve post-operative locoregional control when compared to pre-operative radiotherapy for head and neck cancers. Following surgical resection, adverse pathological features determine the need for adjuvant therapy. High-risk pathologic features include extranodal tumor spread and involved surgical margins. Other adverse pathologic features include T 3-4 tumors, perineural invasion, lymphovascular space invasion, low neck adenopathy, and multiple tumor involved cervical lymph nodes. The standard adjuvant therapies are post-operative radiation therapy or post-operative chemoradiotherapy. Post-operative chemoradiotherapy yields superior locoregional control, progression-free survival, and in some studies, overall survival compared to post-operative radiotherapy for high-risk patients in multiple randomized studies. Pooled analyses of randomized data demonstrate that post-operative concurrent chemoradiotherapy is associated with overall survival benefits for patients with involved surgical margins as well as those with extranodal tumor spread. Post-operative radiotherapy concurrent with cisplatin at 100 mg/m(2) every 21 days is the current standard chemoradiotherapy platform adjuvant head and neck cancer treatment. Post-operative radiotherapy and post-operative chemoradiotherapy radiation treatment volumes are not standardized and should be designed based on the risk of recurrence and clinically occult involvement of head and neck subsites and nodal regions. Evidence supports a post-operative radiotherapy and chemoradiotherapy radiation dose of at least 63 Gy for high-risk patients and at least 57 Gy for low risk patients.
Available from: europepmc.org
- "Although there is growing evidence and indications for use of adjuvant chemoradiotherapy , a wide range of inconsistency still exists in clinical practice . "
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ABSTRACT: To assess the impact of close or positive surgical margins on the outcome, and to determine whether margin status influence the recurrence rate and the overall survival for patients with head and neck cancers.
Records from 1996 to 2001 of 413 patients with primary head and neck squamous cell carcinoma (SCC) treated with surgery as the first line treatment were analysed. Of these patients, 82 were eligible for the study. Patients were followed up for 5 years.
Patients with margins between 5-10 mm had 50% recurrence rate (RR), those with surgical margins between 1-5 mm had RR of 59% and those with positive surgical margins had RR of 90% (P=0.004). The 5-year survival rates were 54%, 39% and 10%, respectively (P=0.002).
Unsatisfactory surgical margin is an independent risk factor for recurrence free survival as well as overall survival regardless of the other tumor and patient characteristics.
Cancer Biology and Medicine 03/2012; 9(1):29-33. DOI:10.3969/j.issn.2095-3941.2012.01.005
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ABSTRACT: Head and neck cancer refers to a group of malignancy that affect the epithelium of the upper aereodigestive tract, primarily the lip and mouth, pharynx and larynx. Head and neck cancer is strongly associated with tobacco smoking, alcohol consumption and betel nut chewing, and indeed a reduction in the exposure to these risk factors has determined a recent decrease in incidence rates in many countries. There remains, however, a significant increase in head and neck cancer rates in those regions where tobacco epidemic continues, as well as in the number of oral cancers related to HPV infection (in particular cancer of the oropharynx, tonsil, and base of the tongue), which typically affect young adults with no history of exposure to tobacco or alcohol. Treatment of head and neck cancer has significantly changed during the last few decades, and an increasing number of individuals are currently offered combined chemoradiotherapy as single treatment modality for organ preservation or in association with surgery to improve prognosis. Unfortunately, the majority of head and neck cancer patients eventually succumb to their disease, with inoperable locoregional recurrences and lack of response to chemoradiotherapy representing the main causes of death. There is an urgent need of novel molecular-targeted therapeutics that could overcome the limitations of current treatment modalities. This paper reviews the characteristics of a novel group of promising antineoplastic agents, poly (ADP-ribose) polymerases (PARP) inhibitors, which cleverly target one of the mechanisms cancer cells use to escape the toxic effect of chemoradiation, and describe the potential benefits of their addition to current limited range of head and neck cancer antineoplastic agents.
Current pharmaceutical design 05/2012; 18(34). DOI:10.2174/138161212803307608 · 3.45 Impact Factor
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ABSTRACT: Surgery of oropharyngeal cancer has evolved from large, open transcervical and transmandibular approaches to minimally invasive transoral endoscopic techniques. Transoral laser microsurgery and transoral robotic surgery allow complete oncologic resection through the mouth with minimal cosmetic deformity and optimal speech and swallow function. With a significant increase in the incidence of oropharyngeal cancers, there is a growing role for up-front surgery, especially in young, healthy patients with human papillomavirus-associated squamous cell carcinoma. This article explores the development of transoral endoscopic surgery, its role in the multidisciplinary treatment of patients with oropharyngeal cancer, and oncologic and functional outcomes.
Otolaryngologic Clinics of North America 08/2012; 45(4):823-44. DOI:10.1016/j.otc.2012.04.006 · 1.49 Impact Factor
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