Can induction chemotherapy and concurrent chemoradiation work in treating unresectable head and neck cancer?
Dr John Ridge - Fox Chase Cancer Center, Philadelphia, USA
Can you tell us about your discussion on head and neck cancer?
I discussed the role of induction chemotherapy and concurrent chemoradiation in treating unresectable cancers of the head and neck.
What is the main specific topic of your study?
The appropriate incorporation of chemotherapy as the first modality in delivery of care for patients whose tumours can’t be removed with an operation. I made additional discussion of cancers of the oral cavity per se because while this meeting does incorporate the head and neck the primary focus is oral cavity tumours.
Did you have recommendations for doctors?
What I did was review some of the results of randomised trials as well as large experiences that don’t really reflect randomised design that demonstrate an important role for induction therapy and concurrent chemoradiation in cancers of the head and neck that can’t be removed. And I discussed some interesting new results coming from South Asia where they have defined four more criteria for tumours that cannot be removed with an operation and shown that one can shrink them if you use chemotherapy as the original modality, the initial modality, and in a substantial minority of patients follow that with an operation which may even prove curative.
What is the current standard practice, and how could this be improved?
I think that the best validated approach for tumours that cannot be removed has been to give chemotherapy as the initial modality and follow it by radiation, either radiation by itself or radiation with the addition of concurrent chemotherapy. When you ask what needs to change, I’m not sure something does need to change, at least in the absence of trial data comparing approaches to find whether tumours that can be removed are better addressed with an operation or radiation as the primary modality.
Do you feel that quality of life issues are important?
They’re important for all patients. Traditionally doctors have worried more about survivorship and patients identify survivorship as what’s most important to them. But they’re certainly disconcerted and often unhappy if we can’t afford a good quality of life. It should never be far removed from our thinking when we’re about to offer a patient an operation.
Is this something that needs to be discussed more with the patient in future?
Some of the side effects of treatment that don’t involve operations, such as radiation with curative intent, also may have adverse effects on quality of life and it is incumbent on all members of a multidisciplinary team to address quality of life and not just quality of life but function because they may be different for patients before initiating therapy and to do our best in the course of treatment and follow-up to ensure good function for patients.
What is your key take-home message?
I guess the key point of my talk really would be that if you’re going to care for patients with advanced malignancy, even more than in limited stage disease, it’s important to have a functioning multidisciplinary team composed of head and neck surgical oncologists, radiation oncologists, medical oncologists, reconstructive surgeons and members of adjunctive subspecialties such as dentistry, speech and language, pathology, rehab and a close working relationship with many other medical specialties.
Can you tell us more about your worldwide collaborations in head and neck treatment?
Some of what I’ve done in the last few years has involved support for the National Cancer Institute’s head and neck steering committee. The National Cancer Institute’s global health initiatives are helping to support an intercontinental research group that we’re trying to establish to permit worldwide collaboration for head and neck oncology. Now, Australia and the US are already continents, international collaboration in Europe has been quite common and well established but we don’t do as well in an intercontinental venue. I think that’s important, particularly so as we better understand the disease and identify smaller and smaller populations for specific targeted therapies
