Title:Integrated Therapeutic Approaches in Head and Neck Cancer: The Importance of Multidisciplinary Team Management
Volume: 13
Issue: 6
Author(s): Francesco Perri, Paolo Muto, Corrado Aversa, Antonio Daponte, Giuseppina Della Vittoria, Stefano Pepe and Francesco Caponigro
Affiliation:
Keywords:
Early stage, Head and neck cancer, Locally advanced disease, Multidisciplinary team, Pathologist, Recurrent/metastatic disease.
Abstract: Multidisciplinary team (MDT) is of paramount importance in the approach to patients with head and neck cancer. Its aim is to
provide the best diagnostic work-up, tumor staging, and treatment. Furthermore, the prognosis of patients who are managed by MDT is
usually better. MDT has a great value in all presentation settings. The role of the pathologist in the team is of utmost importance, in
particular with regards to information provided on Human Papilloma Virus (HPV) status, which has a well acknowledged independent
prognostic value mainly in oropharyngeal carcinoma.
In early stage disease, namely in T1-2 N0 M0 patients, the meetings within the MDT mainly involve surgeons and radiation therapists.
Surgery represents the mainstay of treatment, while radiation therapy is a suitable alternative, in particular in patients with advanced age,
poor performance status and comorbidities.
In locally advanced disease, surgeons, medical oncologists and radiotherapists are the key people, since different approaches have been
carried out. In operable patients, adjuvant chemoradiation is indicated when resection margins are involved or close, or in presence of
extracapsular nodal spread. Concurrent chemoradiotherapy, preceeded or not by induction chemotherapy, is the favourite approach in this
setting when surgery is strictly not indicated.
In recurrent/metastatic disease chemotherapy and best supportive care are the main options, although local treatments, such as
reirradiation and salvage surgery, are also worth considering. The standard chemotherapy treatment has finally evolved after about 30
years, and strong efforts are being pursued to further improve the outcome, mainly with the addition of new drugs.
