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Continuum Cancer Centers of New York (CCCNY) has been a national leader in developing intensive treatment programs for patients with head and neck cancers that coordinate the use of radiation, chemotherapy and surgery. This multidisciplinary team approach has dramatically improved the control of cancer in these patients. Because head and neck cancers affect vital functions like speech and swallowing, preserving quality of life is another critical goal of treatment.
Delivering high doses of radiation is essential to eliminating cancer and preventing its recurrence (maintaining local control). Local control reduces the risk of metastasis but does not eliminate it, since surgery and radiation doesn’t reach cancer implants that have spread through the bloodstream. Chemotherapy, which makes radiation more effective at local control, is necessary to treat metastases. Higher stage cancers have more cancer in the neck and a greater chance of metastases.
Each head and neck cancer site poses individual challenges to the treating team. Treating cancers of the tonsil with high-dose radiation, along with chemotherapy and surgery when needed, has dramatically improved local control, metastases and survival. However, key muscles in swallowing, the pharyngeal constrictor muscles, can be damaged as “innocent bystanders” of radiation treatment.
We recently looked at the outcomes of patients treated by this approach between 1999 through 2005. Although the great majority (75%) had Stage IV cancers, which have the highest risk and require the most intensive treatment, there were few cancer recurrences for all but the most advanced cancers.
There were no recurrences among patients with Stage I or II cancers. Even for more advanced Stage III and IVA cancers, prevention of cancer spread was 93%. However, for the most advanced Stage IVB cancers, only 69% remained cancer free (Figure 1). Surgery (neck dissection) appeared to help prevent tonsil and neck recurrence, although sometimes surgery can’t be performed on the most advanced patients (Figure 2). Patients who received chemotherapy didn’t do better.
Despite the intensive treatment focused on the tonsil, the quality of life outcomes were good for most patients. Only 4% were unable to resume eating and required a feeding tube long term. However, to improve quality of life outcomes further, we now reduce the radiation dose and chemotherapy to patients at lower risk.
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