The Evolving Role of Combined Modality Therapy in Head and Neck Cancer

Kt, Robbins

doi:10.1001/archotol.126.3.265

Cited by 52 publications

(35 citation statements)

References 39 publications

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“…Despite initial promise, a survival advantage has been difficult to demonstrate, particularly after neoadjuvant or sequential treatment. More recently, concurrent chemoradiation (CCRT) has been investigated for the purpose of improving survival and preserving organ function in advanced head and neck cancer [8]. Organ preservation has been a particular focus in studies of innovative nonsurgical approaches to the treatment of hypopharyngeal carcinoma [9,10].…”

Section: Introductionmentioning

confidence: 99%

Treatment results and prognostic factors in locally advanced hypopharyngeal cancer

Lee

Hsiao

et al. 2008

Acta Oto-Laryngologica

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There was no significant difference in T and N status between the two treatment groups, nor were there significant differences in overall or disease-free survival or the incidence of distant metastasis (p >0.05). In the CCRT group and SRT group, the estimated 3-year overall survival was 39% and 44%, respectively. The SRT group had better local control than the CCRT group (p <0.05). Relatively, 27% patients retained their larynx function for more than 2 years in the CCRT group. Radiation doses >70 Gy yielded significantly better survival and local control than doses <70 Gy (p <0.05).

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Section: Introductionmentioning

confidence: 99%

Treatment results and prognostic factors in locally advanced hypopharyngeal cancer

Lee

Hsiao

et al. 2008

Acta Oto-Laryngologica

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“…However, for advanced tumors and, particularly, in situations where the tumor is unresectable or for reasons of organ preservation, chemoradiation therapy is becoming the principal means of disease management. 1 A number of clinical studies have demonstrated the efficacy of cisplatin, one of the most active single agents against SCC, when used in this manner. Although no definitive systemic chemotherapy regimen has yet been established, this route of administration is usually accompanied by dose-limiting systemic drug toxicities and, for cisplatin, by the rapid development of drug resistance.…”

Section: Introductionmentioning

confidence: 99%

Rationale for Intralesional Valrubicin in Chemoradiation of Squamous Cell Carcinoma of the Head and Neck

et al. 2000

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Objectives/Hypothesis: With some advanced squamous cell carcinomas (SCCs) of the head and neck, chemoradiation therapy may obviate the need for surgical intervention. However, both modalities are known to produce organ toxicities, and tumor insensitivity remains problematic. Thus there is a clear need for the development of new treatment strategies. Accordingly, preclinical studies to evaluate the use of valrubicin, a contact-safe, mechanistically novel antitumor agent, combined with low-dose radiation for the therapy of SCC have been conducted. Methods: The comparative in vitro antitumor activities of valrubicin with or without irradiation versus cisplatin were evaluated using human-derived sensitive and cisplatin-resistant SCC cell lines. A hamster cheek pouch model of SCC was used to assess the efficacy of weekly intratumoral valrubicin injections with and without concurrent low-dose irradiation. Results: Valrubicin cytotoxicity was found to be comparable in both sensitive and platinum-resistant cell lines and superior to cisplatin. The addition of minimally cytotoxic cell irradiation (300 -450 cGy) resulted in prolonged G 2 /M cell cycle arrest and a supraadditive increase in apoptotic cell death. In hamsters, once a week ؋ 3 intratumoral drug injections (3, 6, or 9 mg) were growth inhibitory; however, when valrubicin (6 mg) was combined with minimally cytotoxic irradiation (150, 250, or 350 cGy) significant tumor shrinkage was observed. Conclusions: Valrubicin produces supra-additive effects against SCC when combined with low-dose irradiation. This effect appears to correlate with the ability of valrubicin, a cytoplasmic-localizing drug, to inhibit protein kinase C. Therapeutic use of valrubicin against SCC could provide for reduced radiation doses with consequent improved efficacy and reduction in host toxicity.

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“…When analyzing the treatment results of therapies for advanced disease that rely on piecemeal removal, one must keep in perspective the use of adjuvant therapies such as radiation and chemoradiation. 20 When surgical principles for oncology evolved during the late 19th and early 20th centuries, such adjuvant treatment modalities did not exist. The principles were based on the reliance on surgery alone for providing the best chance for cure.…”

Section: Discussionmentioning

confidence: 99%

Removing the Taboo on the Surgical Violation (Cut-Through) of Cancer

Robbins

Bradford

Rodrigo

et al. 2016

JAMA Otolaryngol Head Neck Surg

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S urgical training has traditionally incorporated timehonored rules that are fundamental in providing bestpractice approaches in oncology. Of utmost importance is the goal of completely removing the cancer because positive margins of surgical resection contribute to increased local recurrence and decreased survival rates.1 Also, emphasis is given to the careful handling of the cancerous lesions and the surrounding tissues, primarily to minimize dispersion of cancer cells. However, what has come under recent scrutiny is the longstanding dictum not to surgically violate visible tumor during the extirpative process. It has been taught that cutting through gross tumor during an operation increases the risk of spreading viable cancer cells beyond the tumor and into the surrounding normal tissue. Such a maneuver may cause cancer cells to adhere to surgical instruments and subsequently become inadvertently implanted into the surrounding tissue by means of direct contact of the contaminated object. While documentation of this phenomenon is not prominent in the literature, in the head and neck literature a case report alludes to surgical implantationrelated chest wall tumor following pectoralis major flap reconstruction for a pharyngeal cancer defect. 2 Presumably, tumor cells can be seeded by contaminated instruments used in the extirpative process within the adjacent donor site created to reconstruct a defect following cancer resection. Such events, albeit anecdotal, underscore the importance of the concept for en bloc resection, which for more than a century has remained a widely accepted principle in surgical oncology. Although the principle of en bloc resection remains important, its application for surgical extirpation of cancer within some sites of the head and neck is not always feasible. For example, within the nasopharynx, anterior and lateral skull base, and sinonasal region, surgeons often find it difficult to adhere to this rule. Knowing that the fundamental premise is to remove the tumor with clear margins, head and neck surgeons have traditionally strived to achieve such resections for removing tumors as single intact specimens. However, too often the pathologist receives specimens that have been removed in multiple pieces. With some reservations, it is likely that such experiences have led to the acceptance of piecemeal removal of cancer in select situations when monobloc resection is not feasible or practical and as long as complete resection is achieved with clear margins.Exactly when the attitude of accepting piecemeal removal of cancer began remains unclear. The evidence points to a gradual evolution. The early examples of tumor cut-through evolved under circumstances that were more subtle. For example, the surgical technique of Mohs for cutaneous malignant neoplasms has been practiced by dermatologists for more than half a century. In principle, this technique involves serial excisions parallel to the tumor margins until there is clearance of cancer cells. Although the intent is not to deliberately c...

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The Evolving Role of Combined Modality Therapy in Head and Neck Cancer

Cited by 52 publications

References 39 publications

Treatment results and prognostic factors in locally advanced hypopharyngeal cancer

Treatment results and prognostic factors in locally advanced hypopharyngeal cancer

Rationale for Intralesional Valrubicin in Chemoradiation of Squamous Cell Carcinoma of the Head and Neck

Removing the Taboo on the Surgical Violation (Cut-Through) of Cancer

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