Management of advanced nodal disease in patients treated with primary chemoradiotherapy

Mehanna, Hisham; Wong, Wai Lup; Dunn, Janet A.

doi:10.1097/cco.0000000000000283

Cited by 4 publications

(1 citation statement)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surgery is the mainstay of treatment, with radiotherapy advocated in about 60% of patients in the definitive (chemo)radiotherapy or postoperative (poRT) setting ( 3 ). Primary tumor resection is increasingly performed using reconstructive surgery and mini-invasive/mini-morbid approaches, with de-escalation when appropriate ( 4 , 5 ). Reconstructive surgery aims to mitigate the effects of tumor resection and is standard practice in many cancer sites ( 6 ) to restore the anatomy and function.…”

Section: Introductionmentioning

confidence: 99%

Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Thariat,

Carsuzaa,

Beddok

et al. 2024

Front. Oncol.

View full text Add to dashboard Cite

BackgroundMajor advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy.MethodsA systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT.ResultsDespite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap–tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications.ConclusionFlap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning.

show abstract

Section: Introductionmentioning

confidence: 99%

Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Thariat,

Carsuzaa,

Beddok

et al. 2024

Front. Oncol.

View full text Add to dashboard Cite

show abstract

The Effects of Human Papillomavirus Status and Treatment on the Positive Predictive Value of Post-radiotherapy 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Advanced Head and Neck Squamous Cell Carcinoma

Zhou,

Chan,

Lau

et al. 2023

Clinical Oncology

View full text Add to dashboard Cite

Utility of a repeat PET/CT scan in HPV-associated Oropharyngeal Cancer following incomplete nodal response from (chemo)radiotherapy

et al. 2019

View full text Add to dashboard Cite

Management of advanced nodal disease in patients treated with primary chemoradiotherapy

Abstract: There is now level 1 evidence to support image-guided surveillance strategies as the standard of care for advanced nodal disease in patients treated with primary chemoradiotherapy.

Cited by 4 publications

References 15 publications

Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

The Effects of Human Papillomavirus Status and Treatment on the Positive Predictive Value of Post-radiotherapy 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Advanced Head and Neck Squamous Cell Carcinoma

Utility of a repeat PET/CT scan in HPV-associated Oropharyngeal Cancer following incomplete nodal response from (chemo)radiotherapy

Contact Info

Product

Resources

About