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Conservation surgery for radiation failure of early staged larynx cancer
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Symposia/Proffered Papers Management of the Failing Patients 51 speaker CONSERVATION SURGERYFOR RADIATION FAILUREOF EARLY STAGED LARYNX CANCER J.P. Shah MEMORIALSLOAN-KETTERINGCANCERCENTRE,Head and Neck Department,
New York,USA Conservation surgery in selected patients with early-staged squamous cell carcinomas of the larynx who have failed initial radiation therapy is technically feasible. Reports in the literature regarding tumor control rates and preservation of voice following partial laryngectomy for radiation failure carcinomas of the glottic larynx and selected patients with carcinomas of the supraglottic larynx are encouraging. In the management of cancer of the larynx, the two most important goals are eradication of cancer and preservation of the function of larynx. In early-staged cancers of the larynx (TI and T2), functional preservation of larynx can be accomplished via endoscopic laser resection of the tumor or an open partial laryngectomy. On the other hand, external radiation therapy alone is often equally effective in control of cancer and preservation of an excellent quality of voice. However, when radiotherapy fails, the feasibility of a conservation operation becomes less likely. In select patients, however, the technical feasibility of a conservation operation exists even after failure to initial radiotherapy for earlystaged carcinomas of the glottic and supraglottic larynx. Careful patient selection and accurate assessment of the extent of the tumor prior to radiotherapy and at the time of recurrence is crucial to the successful outcome of conservation surgery in this clinical setting. If the primary tumor was amenable to a conservation operation prior to radiation therapy and if the persistent or recurrent tumor is still within the same confines then technically a conservation operation is feasible. Needless to say, patient selection is also crucial particularly with reference to pulmonary reserve and ability to handle delayed healing, chronic aspiration and difficulties in swallowing. The conservation operations may be a supraglottic partial laryngectomy, hemilaryngectomy, anterolateral vertical partial laryngectomy or a supracricoid subtotal laryngectomy. Tumor control rates in excess of 70 percent five year disease free survival are reported in the literature for glottic larynx, although, no significant data exists regarding conservation surgery for radiation failure carcinomas of the supraglottic larynx.Technical aspects of endoscopic evaluation, operative procedures and outcomes of conservation surgery will be shown during this presentation. 52 speaker SALVAGE SURGERY AFTER CHEMO-RADIATION FOR ADVANCED HNSCC
Saturday, February 24, 2007 and neck cancer are Iocoregional relapse and/or the development of second primary tumours (SPT) in previously irradiated areas. Recurrent and second primary head and neck squamous cell carcinoma (HNSCC) in previously irradiated areas poses a significant therapeutic challenge. In these cases, salvage surgery is the treatment of choice. However, in many cases, surgery is not feasible because of tumour extent, poor medical status of the patient and/or unacceptable expected morbidity. In these cases, re-irradiation either alone or in combination with chemotherapy, is the only potentially curative option. In the last decades re-irradiation has begun to gain conceptual acceptance, as experimental and clinical studies have demonstrated that high dose re-irradiation can be administered successfully in a significant proportion of patients without unacceptable late toxicity. The results of recently published studies, in particular in the postoperative setting, clearly indicate that a second course of radiation with a curative dose results in improved Iocoregional tumour control without unacceptable late radiation-iduced toxicity. In this presentation, the results of studies regarding re-irradiation as primary or adjuvant treatment modality for head and neck recurrences or SPT in previously irradiated areas will be reviewed. High dose reirradiation as salvage treatment in case of recurrent or second primary head and neck cancer should be considered, particularly when salvage surgery is not feasible. Further optimisation of re-irradiation could be achieved by intergrating altered fractionation schedules with advanced radiation delivery techniques such as IMRT, the use of selective target volume definition and the combination with new chemotherapy regimens and molecular targetting agents. 54 speaker PALLIATIVE MEDICAL TREATMENT K. BjordalTHE NORWEGIANRADIUMHOSPITAL,Department of Medical Oncology and
Radiotherapy,Oslo,Norway H&N patients with Iocoregional recurrences or metastatic disease for which further surgery or radiation is not possible will no longer be candidates for curative treatment. However, the patients should be offered medical palliative treatment and best supportive care. Such treatment might be given in order to prolong life, but even more important to relive or prevent symptoms. The treatment intention and expected effect of any given medical intervention should be clarified, both for the health care workers and for the patients and his/her family. In any of these circumstances, we have to assure that the treatment dose not give side effects with more negative implcations to the patient's daily life than the disease itself. Palliative chemotherapy, and evaluation of palliative medical treatment will be discussed. 55 oral
S. Temam INSTITUTGUSTAVEROUSSY,Head and Neck Surgery Department, Villejuif,
France Abstract not received. 53 speaker RE-IRRADIATION FOR HNSCC J. Langendijk UNIVERSITYMEDICALCENTERGRONINGEN/UNIVERSITYOF GRONINGEN,Radiation
Oncology, Groningen,The Netherlands The main reasons for treatment failure after combined or single modality treatment, including radiotherapy for locally advanced head
RANDOMISED TRIAL OF RE-IRRADIATION COMBINED WITH CHEMOTHERAPY AFTER SALVAGE SURGERY IN HEAD AND NECK CARCINOMA: CARCINOLOGIC AND QUALITY OF LIFE RESULTS GETTEC AND GORTEC GROUPS F. Janot I, D. de Raucourt2,M. Castaing ~, R. Giger I, E. Babin 3,C. Ferron4, G. Dolivets, JR. Bensadoun6, M. Hamoir 7, M. Julieron ~,G. Mamelle ~,J. Bourhis ~ IINSTITUTGUSTAVEROUSSY,Villejuif, France, 2CENTREFRANC~OIS[3ACLESSE,Caen,France, ~CHU, Caen,France, 4CENTREREN~GAUDUC~EAU,Nantes,France, 5CENTREALEXISVAUTR~N,Nancy,France, 6CENTREA. LACCASSAGNE,Nice,France, 7CLINIQUESUNIVERSITAmESST. LUGBrussels,Belgium
Symposia/Proffered Papers Management of the Failing Patients 51 speaker CONSERVATION SURGERYFOR RADIATION FAILUREOF EARLY STAGED LARYNX CANCER J.P. Shah MEMORIALSLOAN-KETTERINGCANCERCENTRE,Head and Neck Department,
New York,USA Conservation surgery in selected patients with early-staged squamous cell carcinomas of the larynx who have failed initial radiation therapy is technically feasible. Reports in the literature regarding tumor control rates and preservation of voice following partial laryngectomy for radiation failure carcinomas of the glottic larynx and selected patients with carcinomas of the supraglottic larynx are encouraging. In the management of cancer of the larynx, the two most important goals are eradication of cancer and preservation of the function of larynx. In early-staged cancers of the larynx (TI and T2), functional preservation of larynx can be accomplished via endoscopic laser resection of the tumor or an open partial laryngectomy. On the other hand, external radiation therapy alone is often equally effective in control of cancer and preservation of an excellent quality of voice. However, when radiotherapy fails, the feasibility of a conservation operation becomes less likely. In select patients, however, the technical feasibility of a conservation operation exists even after failure to initial radiotherapy for earlystaged carcinomas of the glottic and supraglottic larynx. Careful patient selection and accurate assessment of the extent of the tumor prior to radiotherapy and at the time of recurrence is crucial to the successful outcome of conservation surgery in this clinical setting. If the primary tumor was amenable to a conservation operation prior to radiation therapy and if the persistent or recurrent tumor is still within the same confines then technically a conservation operation is feasible. Needless to say, patient selection is also crucial particularly with reference to pulmonary reserve and ability to handle delayed healing, chronic aspiration and difficulties in swallowing. The conservation operations may be a supraglottic partial laryngectomy, hemilaryngectomy, anterolateral vertical partial laryngectomy or a supracricoid subtotal laryngectomy. Tumor control rates in excess of 70 percent five year disease free survival are reported in the literature for glottic larynx, although, no significant data exists regarding conservation surgery for radiation failure carcinomas of the supraglottic larynx.Technical aspects of endoscopic evaluation, operative procedures and outcomes of conservation surgery will be shown during this presentation. 52 speaker SALVAGE SURGERY AFTER CHEMO-RADIATION FOR ADVANCED HNSCC
Saturday, February 24, 2007 and neck cancer are Iocoregional relapse and/or the development of second primary tumours (SPT) in previously irradiated areas. Recurrent and second primary head and neck squamous cell carcinoma (HNSCC) in previously irradiated areas poses a significant therapeutic challenge. In these cases, salvage surgery is the treatment of choice. However, in many cases, surgery is not feasible because of tumour extent, poor medical status of the patient and/or unacceptable expected morbidity. In these cases, re-irradiation either alone or in combination with chemotherapy, is the only potentially curative option. In the last decades re-irradiation has begun to gain conceptual acceptance, as experimental and clinical studies have demonstrated that high dose re-irradiation can be administered successfully in a significant proportion of patients without unacceptable late toxicity. The results of recently published studies, in particular in the postoperative setting, clearly indicate that a second course of radiation with a curative dose results in improved Iocoregional tumour control without unacceptable late radiation-iduced toxicity. In this presentation, the results of studies regarding re-irradiation as primary or adjuvant treatment modality for head and neck recurrences or SPT in previously irradiated areas will be reviewed. High dose reirradiation as salvage treatment in case of recurrent or second primary head and neck cancer should be considered, particularly when salvage surgery is not feasible. Further optimisation of re-irradiation could be achieved by intergrating altered fractionation schedules with advanced radiation delivery techniques such as IMRT, the use of selective target volume definition and the combination with new chemotherapy regimens and molecular targetting agents. 54 speaker PALLIATIVE MEDICAL TREATMENT K. BjordalTHE NORWEGIANRADIUMHOSPITAL,Department of Medical Oncology and
Radiotherapy,Oslo,Norway H&N patients with Iocoregional recurrences or metastatic disease for which further surgery or radiation is not possible will no longer be candidates for curative treatment. However, the patients should be offered medical palliative treatment and best supportive care. Such treatment might be given in order to prolong life, but even more important to relive or prevent symptoms. The treatment intention and expected effect of any given medical intervention should be clarified, both for the health care workers and for the patients and his/her family. In any of these circumstances, we have to assure that the treatment dose not give side effects with more negative implcations to the patient's daily life than the disease itself. Palliative chemotherapy, and evaluation of palliative medical treatment will be discussed. 55 oral
S. Temam INSTITUTGUSTAVEROUSSY,Head and Neck Surgery Department, Villejuif,
France Abstract not received. 53 speaker RE-IRRADIATION FOR HNSCC J. Langendijk UNIVERSITYMEDICALCENTERGRONINGEN/UNIVERSITYOF GRONINGEN,Radiation
Oncology, Groningen,The Netherlands The main reasons for treatment failure after combined or single modality treatment, including radiotherapy for locally advanced head
RANDOMISED TRIAL OF RE-IRRADIATION COMBINED WITH CHEMOTHERAPY AFTER SALVAGE SURGERY IN HEAD AND NECK CARCINOMA: CARCINOLOGIC AND QUALITY OF LIFE RESULTS GETTEC AND GORTEC GROUPS F. Janot I, D. de Raucourt2,M. Castaing ~, R. Giger I, E. Babin 3,C. Ferron4, G. Dolivets, JR. Bensadoun6, M. Hamoir 7, M. Julieron ~,G. Mamelle ~,J. Bourhis ~ IINSTITUTGUSTAVEROUSSY,Villejuif, France, 2CENTREFRANC~OIS[3ACLESSE,Caen,France, ~CHU, Caen,France, 4CENTREREN~GAUDUC~EAU,Nantes,France, 5CENTREALEXISVAUTR~N,Nancy,France, 6CENTREA. LACCASSAGNE,Nice,France, 7CLINIQUESUNIVERSITAmESST. LUGBrussels,Belgium