Overview of treatment for head and neck cancer
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- Kerstin M Stenson, MD, FACS
Kerstin M Stenson, MD, FACS
- Professor of Otolaryngology
- Chief, Head and Neck Cancer Program, Rush University Medical Center
- Department of Otolaryngology/Head and Neck Surgery
- Shiyu Song, MD, PhD
Shiyu Song, MD, PhD
- Associate Professor of Radiation Oncology
- Virginia Commonwealth University Health System
- Section Editors
- Marshall R Posner, MD
Marshall R Posner, MD
- Section Editor — Cancer of the Head and Neck
- Professor of Gene and Cell Medicine
- The Tisch Cancer Institute
- Icahn School of Medicine at Mount Sinai
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
Most head and neck cancers begin in the mucosal surfaces of the upper aerodigestive tract, and these are predominantly squamous cell carcinomas.
An overview of treatment for head and neck squamous cell carcinomas will be presented here. An overview of the diagnostic approach and staging of head and neck cancers is presented separately. (See "Overview of the diagnosis and staging of head and neck cancer".)
Malignancies arising in other organs within the head and neck regions are discussed in the relevant site-specific topics.
INTEGRATED APPROACH TO MANAGEMENT
A multidisciplinary approach is required for optimal decision making, treatment planning, and posttreatment response assessment. This should include surgeons, medical oncologists, and radiation oncologists, as well as dentists, speech/swallowing pathologists, dieticians, and rehabilitation therapists. Specifically, a multidisciplinary tumor board affects diagnostic and treatment decisions in a significant number of patients with newly diagnosed head and neck tumors .
Furthermore, complex cases of head and neck cancer should be treated at high-volume centers whenever possible, where expertise in each of these disciplines may be better [2,3]. An analysis of outcomes from a large randomized trial (Radiation Therapy Oncology Group [RTOG] 0129) found that patients treated at centers with historically high accrual to head and neck clinical trials had a significantly better five-year overall survival rate compared with those treated at centers with historically low accrual (69 versus 51 percent) . These differences could not be explained based upon differences in the prognostic factors of enrolled patients [1,3,5].
- Wheless SA, McKinney KA, Zanation AM. A prospective study of the clinical impact of a multidisciplinary head and neck tumor board. Otolaryngol Head Neck Surg 2010; 143:650.
- Corry J, Peters LJ, Rischin D. Impact of center size and experience on outcomes in head and neck cancer. J Clin Oncol 2015; 33:138.
- Boero IJ, Paravati AJ, Xu B, et al. Importance of Radiation Oncologist Experience Among Patients With Head-and-Neck Cancer Treated With Intensity-Modulated Radiation Therapy. J Clin Oncol 2016; 34:684.
- Wuthrick EJ, Zhang Q, Machtay M, et al. Institutional clinical trial accrual volume and survival of patients with head and neck cancer. J Clin Oncol 2015; 33:156.
- Tribius S, Donner J, Pazdyka H, et al. Survival and overall treatment time after postoperative radio(chemo)therapy in patients with head and neck cancer. Head Neck 2016; 38:1058.
- Part II Head and Neck. In: AJCC Cancer Staging Manual, 8th, Amid MB, (Ed), Springer, New York 2017. p.53.
- Furness S, Glenny AM, Worthington HV, et al. Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy. Cochrane Database Syst Rev 2010; :CD006386.
- Pignon JP, le Maître A, Maillard E, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009; 92:4.
- O'Sullivan B, Huang SH, Su J, et al. Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study. Lancet Oncol 2016; 17:440.
- INTEGRATED APPROACH TO MANAGEMENT
- ANATOMIC SUBSITES
- TNM STAGING SYSTEM
- MANAGEMENT OF SQUAMOUS CELL CARCINOMAS
- Localized (early stage) disease
- Locoregionally advanced disease
- Management of the neck
- Reconstruction and rehabilitation
- Posttreatment evaluation and surveillance
- Locally recurrent disease
- Metastatic disease
- SPECIAL CIRCUMSTANCES
- Human papillomavirus associated oropharyngeal cancer
- Nasopharyngeal carcinoma
- Nasal vestibule and nasal cavity cancers
- Paranasal sinus cancer
- Salivary gland cancers
- Squamous cell carcinoma of unknown primary
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS