Conservation Therapy in Patients with Head and Neck Carcinoma

Abstract

Head and neck cancer represents 3.6 to 5% of all malignancies in the United States. However, the potential functional, cosmetic and psychological repercussions, resulting from treatment of this disease significantly impacts the patient’s quality of life. A coordinated multidisciplinary team approach for the treatment and follow-up of head and neck cancer patients is crucial for optimal patient management. Standard therapy of early (stage I or II) head and neck cancers consists of radiation alone or surgical resection. Five-year survival statistic for these patients range from 60 to 95%. For advanced cancers (stage III or IV), standard therapy is comprised of surgery plus radiation therapy. The surgical defects are often difficult to rehabilitate. The 5-year survival statistics range from 10 to 60%, depending on the site, but are usually less than 30%. In an effort to improve survival and reduce the need for extensive surgical resections, researchers have utilized induction chemotherapy in several randomized trials for patients with advanced head and neck cancer. Although not been shown to improve survival, induction chemotherapy has played a role in organ preservation as a part of combined modality program for patients with advanced disease. Conservation surgical techniques involve mandible-sparing procedures, laryngeal preservation surgeries and selective or ‘functional’ neck dissections. Free-tissue transfer using microvascular techniques has dramatically increased the surgeon’s reconstructive armamentarium. Patients are experiencing more functional and cosmetic outcomes despite extensive cancer resections. Finally, concomitant chemoradiotherapy has emerged as one of the most promising treatment approaches for patients with advanced stage head and neck cancer. Studies show trends toward improved survival with preservation of organ and function in patients with this devastating disease.