Therapeutic implications of narrow or positive surgical margins in head and neck tumors

Abstract

IntroductionThe treatment of squamous cell carcinomas of the head and neck region involves a multidisciplinary approach that combines surgery, radiotherapy and chemotherapy.AimThe aim of this article is to discuss the therapeutic implications of narrow or positive surgical margins in head and neck cancers.Material and methodsThe article was written based on the analysis of the literature on the subject.Results and discussionSurgical resection is an important part of a approach to treatment and the adequacy of resection during surgery is determined by the margin status. A margin greater than 5 mm is considered free, less than 5 mm - narrow, and less than one mm is considered positive. For proper planning of radiotherapy, i.e. adequate selection of areas and doses, the following are necessary: imaging, endoscopy, pathology report. It should also be remembered that the lack of important information from the treatment and the fear of making a geographical error and/or not matching the dose to the actual stage of the disease and the status of the margins; affects the decision of the radiotherapist who will escalate the dose, which may lead to long-term tissue damage with loss of their function and significantly affect the quality of life of these patients.ConclusionsBefore initiating treatment, each patient should undergo analysis in multidisciplinary consultations to tailor the optimal therapeutic decision to the stage of the disease and any coexisting conditions.Patients with advanced disease and/or challenging localization and/or rare disease diagnoses should be treated in highly specialized centers where close collaboration between facilities is essential.