Squamous Cell Head and Neck Cancer

Abstract

This book is part of the Current Clinical Oncology series and is preceded by 14 other topics, notably the common tumours of lung, breast and colorectal as well as more diverse subjects such as hepatocellular carcinoma, myeloma and intra-operative irradiation. Now it is the turn of squamous cell head and neck cancer. This is a multi-author book written by 48 medical/radio oncologists and unashamedly American in perspective with only one author from Europe (Jacques Bernier) and four from the National Cancer Institute of Singapore. In terms of the target audience, this is a studious work with few illustrations, produced in dense type and replete with references. It is a treasure trove for the student writing a paper or applying for a grant but not an easy read. The book does not deal with broad issues and is likely to confuse the uninitiated. The first chapter deals with risk factors for head and neck cancer of those in the population that do not smoke or drink. This small cohort of patients has attracted attention because of the association with human papilloma virus and the potential for a vaccine solution. Other factors addressed are relatively inconsequential such as diet, genetic predisposition, immune deficiency, etc. The next four chapters deal with surgical topics: the first is laryngeal preservation surgery, which is a well-established subject – nothing much new here. The next topic is laser therapy, where the European results of larynx and oropharyngeal surgery are noteworthy. The following chapter discusses the role of neck dissection in the context of organ preservation therapy. The issue is whether a patient with positive cervical lymphadenopathy needs a complete neck dissection after chemoradiation. The answer is that this is only necessary for patients with disease greater than N1. The third chapter deals with surgical salvage after failed chemoradiation (organ preservation therapy) and here there may be a surveillance role for PET in detecting persistent disease. We will have to wait for the answer. Chapters 6–10 deal with radiotherapy issues; first, the management of the T3–T4 tumour of the larynx. The authors provide a wealth of detail on the subject and conclude that careful case selection is important for the outcome. The next chapter deals with brachytherapy, a subject with a long history but again there is little new to report. In chapter 8, intensity-modulated radiation therapy is described but it is too early to expect a realistic account of its performance. However, the next chapter on accelerated and hyperfraction radiation therapy does provide answers within the final analysis – an assertion that the more radiation targeted on the tumour, the greater is the chance of cure. The remaining half of the book covers medical oncology. The role of traditional induction chemotherapy is dispatched quickly but its application in organ preservation is fully developed in the succeeding two chapters. These convey the reality of a fast-moving topic breaking new ground, where the advantage now lies with multimodality therapy. Concomitant chemoradiation gives up to an 8% improvement in survival across all stages of disease. Nevertheless, there is a catch as it does not extend to all age groups, as by the age of 70 years the survival advantage is lost. Chapters 16–19 deal with novel therapies including attempts to protect normal tissue from radiation damage and new therapy targeted at neovascularisation, cell cycle pathways and gene manipulation. Herein lie the innovations for the future and studies are already being designed to trial these molecules in the head and neck. It would be prescient for surgical oncologists to digest the chemoradiation chapters if they want to be prepared for impending environmental change. All in all, this is a book packed with data giving glimpses of the future. It is a must for insomniacs.