Multidisciplinary Management of Locally Advanced SCCHN: Optimizing Treatment Outcomes

Abstract

The management of locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) is highly complex. Data from recent clinical trials have altered the treatment landscape by refining the use of existing therapies, such as radiation therapy and chemotherapy, and providing new treatment options, such as cetuximab. Selecting the most appropriate treatment for an individual patient requires a multidisciplinary approach and careful assessment of the relative advantages and disadvantages of each treatment approach. Surgery is highly effective but can have debilitating long-term consequences. Chemoradiation and altered fractionation radiation therapy are more effective than conventional radiation therapy, but also more toxic; as a consequence of toxicity, suboptimal delivery of radiation may diminish, in practice, the efficacy observed in clinical trials of these strategies. Cetuximab plus radiation therapy is more effective than radiation alone and does not substantially increase radiation-related toxicity, or affect the delivery of planned radiotherapy. However, whether cetuximab plus radiation therapy is similar in efficacy to chemoradiation is unknown at this time. Ideally, multidisciplinary teams weigh all these factors when making individual treatment decisions. Data from current trials will help further optimize multimodality treatment for LA-SCCHN. The Oncologist 2008;13:899 -910

Incidence of dermatitis in head and neck cancer patients treated with primary radiotherapy and cetuximab

“…The cornerstones of treatment for patients with locally advanced unresectable head and neck cancer are surgery and radiotherapy, which might be delivered alone or in various combinations with chemotherapy [1,6,12,16,20,22,24,26]. With the recent introduction of cetuximab in the treatment of locally advanced non resectable head and neck cancer, an attractive novel therapeutic option has been provided to the head and neck oncologist, with potentially the same efficacy, but less side effects than observed during radiochemotherapy [4,9,10].…”

CT-guided cryoablation for palliation of secondary trigeminal neuralgia from head and neck malignancy

“…The management and treatment of patients with invasive head and neck malignancy is complex and varies according to clinical presentation and clinician expertise 19. For example, radiotherapy and/or surgery is used in patients with stage I and most stage II SCC of the head and neck as cure is the primary objective 20.…”

“…However, most patients with SCC of the head and neck present with stage III or IV disease 21. Conventional treatment for these patients has been chemotherapy, radiotherapy or a combination (chemoradiotherapy) 19 20. Nevertheless, these conventional treatments do have some adverse effects.…”

Mature Results of a Randomized Trial of Accelerated Hyperfractionated Versus Conventional Radiotherapy in Head-and-Neck Cancer

“…Despite the fact that the same grading system is used, many of the events classified by the RTOG/ European Organisation for Research and Treatment of Cancer scoring system as severe are more extreme and life-threatening than those identified as severe with the Dische Dictionary Scoring System and were rarely encountered in the CHART trial. A number of strategies to improve the therapeutic benefit in the treatment of head-and-neck cancer are under investigation (4,(21)(22)(23)(24). One such strategy is the targeting of the tumor epidermal growth factor receptor with inhibitors, and there are a wealth of clinical studies evaluating the use of molecular therapeutics with RT in the head and neck (25).…”