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S10 Surgical treatment of oropharyngeal tumors
68 Surgical salvage remains the most effective treatment modality for advanced recurrent oral cancer. However, the decision as to when surgery in this setting is reasonable or not, can be difficult. Through the use of illustrative case studies the factors important in deciding when to operate and when not to operate will be discussed. The evaluation of the patient with recurrent advanced cancer mandates a special emphasis on needed historical, current, and imaging information. Factors important in predicting success such as performance status, comorbidity, tumor extent and behavior, and prior treatment, must all be considered. Surgical planning including the use of intra-operative radiation therapy and microvascular free flap reconstruction is more problematic in the case of recurrent cancer. It is just as important to be aware of factors that would contraindicate an attempt at surgical salvage. In this decision area there are some absolutes, but usually a decision not to operate is based on numerous factors that apply individually to the patient. When not to operate, thus setting the limits for ablative surgery for recurrent advanced oral cancer, will also be reviewed in detail.
Symposium European Head and Neck Society
Oropharyngeal cancer: modern management S9 Molecular diagnosis: current prospects G.A.M.S. van Dongen *. VU University Medical Center, The Netherlands The most important advances in cancer research during the last decades have been in the fields of molecular biology and cell biology. It has been learned that during cancer development several critical molecular changes take place in cells, for example changes that affect proliferation, death, differentiation, metabolism, cell-cell contact, immunogenicity, and interaction with the blood supply of the host. With powerful high-throughput techniques that measure genetic alterations and gene expression, molecules can be identified that play a critical role in the malignant behavior of tumors. Typical examples of such critical molecules in head and neck cancer are the epidermal growth factor and its receptor (EGFR) and the vascular endothelial growth factor (VEGF) and its receptors. These molecules are also exploited in strategies of targeted therapy with small molecules and monoclonal antibodies (MAbs). To confirm the expression of these target molecules in individual patients, one has to rely on ex vivo immunohistochemical staining of tumor biopsies. We aim to develop imaging tools to confirm, visualize and quantitate expression of such critical molecular targets also in vivo, in individual head and neck cancer patients, using positron emission tomography (PET) or PET-CT as the imaging modalities. For this purpose, on the analogy of in vitro immunohistochemistry, MAbs (radiolabeled) are used as tumorspecific contrast agents. We coin this technology immuno-PET. Potential applications of immuno-PET for diagnosis and therapy planning in head and neck oncology will be discussed [1]. Reference(s) [1] B¨ orjesson PKE et al. Performance of immuno-PET with zirconium-89-labeled chimeric monoclonal antibody U36 in the detection of lymph node metastases in head and neck cancer patients. Clin Cancer Res 2006; 12: 2133 40.
Oral and Symposium abstracts, Friday 18 May S10 Surgical treatment of oropharyngeal tumors M. Julieron *. France For oropharyngeal tumors, the use of surgery followed by radiotherapy increased during the last past years, despite the significant improvements in radio(chemo)therapy. This is partly due to the progress in conservative/reconstructive procedures, and the refinements in oropharyngeal subsitesspecific analysis. The aim of the presentation will be: To focus on the subsites which are known to respond poorly to primary radiation: In our experience tumors arising from the glossotonsillar sulcus, posterior pharyngeal wall, vallecula and endophytic tumors of the base of tongue are localisations preferably treated by surgery followed by postoperative radiotherapy. emphasize the intersest of conservative surgical approaches as supraglottic laryngectomy, mandibulotomy and lateral pharyngotomy for these lesions and specify the indications and technical points to ensure a safe resection. review the benefits and the indications of reconstructive surgery in oropharyngeal tumors. And specify the new problems posed by salvage surgery in patients who underwent radiotherapy with modification of fractionnation, concomitant chemotherapy or both. The rate of patients with local or regional falure being able to undergo salvage surgery is likely to be lower than after conventional radiotherapy, postoperative complications seem to be more frequent and severe. How to manage these patients? Due to the progress of all therapeutic approaches in oropharyngeal tumors, the place of surgery must be clarified. S11 Chemoradiotherapy for advanced oropharyngeal carcinoma C.M. Nutting *. Royal Marsden Hospital, UK The role of chemoradiation for oropharyngeal carcinoma is expanding, being used as both adjuvant therapy, in high risk cases after surgery, or increasingly as a complete alternative to radical surgery. This presentation will review the clinical research data pertaining to chemoradiation in these settings. Advances in recent chemotherapy and radiation delivery will be discussed. Clinical results of current intensity modulated radiotherapy (IMRT) trials in oropharyngeal cancer will be presented, and the role of this new modality of therapy in avoidance of xerostomia reviewed. S12 Functional results after treatment J. Olofsson *. Haukeland University Hospital, Norway Survival figures for especially advanced oropharyngeal carcinoma remain low despite modern treatment. Over all 5-year survival is in many studies reported to around 30%. A Finnish study by Makitie et al. (2006) reached 45%. Pfister et al. (1995) reported a 41% over all survival by induction chemotherapy with cisplatin and definitive radiotherapy. Kohno (2004) used induction chemotherapy followed by concurrent chemoradiotherapy in responders. Interstitial brachytherapy has also been recommended. However, Petruson et al. (2005) reported significant problems with dry mouth and swallowing of solid foods throughout a 3-year follow-up study in such patients. Parsons et al. (2002) recommended RT±ND for the majority of patients, especially focusing on functional consequences of treatment. Pourel et al. (2002) found significantly impaired QOL in longterm survivors, especially looking at psychosocial parameters. They stressed the role of coping processes. Woolley et al. (2005) did not see that deprivation was related to more advanced disease. Mehanna and Morton (2006) noted
Symposium European Head and Neck Society
Oropharyngeal cancer: modern management S9 Molecular diagnosis: current prospects G.A.M.S. van Dongen *. VU University Medical Center, The Netherlands The most important advances in cancer research during the last decades have been in the fields of molecular biology and cell biology. It has been learned that during cancer development several critical molecular changes take place in cells, for example changes that affect proliferation, death, differentiation, metabolism, cell-cell contact, immunogenicity, and interaction with the blood supply of the host. With powerful high-throughput techniques that measure genetic alterations and gene expression, molecules can be identified that play a critical role in the malignant behavior of tumors. Typical examples of such critical molecules in head and neck cancer are the epidermal growth factor and its receptor (EGFR) and the vascular endothelial growth factor (VEGF) and its receptors. These molecules are also exploited in strategies of targeted therapy with small molecules and monoclonal antibodies (MAbs). To confirm the expression of these target molecules in individual patients, one has to rely on ex vivo immunohistochemical staining of tumor biopsies. We aim to develop imaging tools to confirm, visualize and quantitate expression of such critical molecular targets also in vivo, in individual head and neck cancer patients, using positron emission tomography (PET) or PET-CT as the imaging modalities. For this purpose, on the analogy of in vitro immunohistochemistry, MAbs (radiolabeled) are used as tumorspecific contrast agents. We coin this technology immuno-PET. Potential applications of immuno-PET for diagnosis and therapy planning in head and neck oncology will be discussed [1]. Reference(s) [1] B¨ orjesson PKE et al. Performance of immuno-PET with zirconium-89-labeled chimeric monoclonal antibody U36 in the detection of lymph node metastases in head and neck cancer patients. Clin Cancer Res 2006; 12: 2133 40.
Oral and Symposium abstracts, Friday 18 May S10 Surgical treatment of oropharyngeal tumors M. Julieron *. France For oropharyngeal tumors, the use of surgery followed by radiotherapy increased during the last past years, despite the significant improvements in radio(chemo)therapy. This is partly due to the progress in conservative/reconstructive procedures, and the refinements in oropharyngeal subsitesspecific analysis. The aim of the presentation will be: To focus on the subsites which are known to respond poorly to primary radiation: In our experience tumors arising from the glossotonsillar sulcus, posterior pharyngeal wall, vallecula and endophytic tumors of the base of tongue are localisations preferably treated by surgery followed by postoperative radiotherapy. emphasize the intersest of conservative surgical approaches as supraglottic laryngectomy, mandibulotomy and lateral pharyngotomy for these lesions and specify the indications and technical points to ensure a safe resection. review the benefits and the indications of reconstructive surgery in oropharyngeal tumors. And specify the new problems posed by salvage surgery in patients who underwent radiotherapy with modification of fractionnation, concomitant chemotherapy or both. The rate of patients with local or regional falure being able to undergo salvage surgery is likely to be lower than after conventional radiotherapy, postoperative complications seem to be more frequent and severe. How to manage these patients? Due to the progress of all therapeutic approaches in oropharyngeal tumors, the place of surgery must be clarified. S11 Chemoradiotherapy for advanced oropharyngeal carcinoma C.M. Nutting *. Royal Marsden Hospital, UK The role of chemoradiation for oropharyngeal carcinoma is expanding, being used as both adjuvant therapy, in high risk cases after surgery, or increasingly as a complete alternative to radical surgery. This presentation will review the clinical research data pertaining to chemoradiation in these settings. Advances in recent chemotherapy and radiation delivery will be discussed. Clinical results of current intensity modulated radiotherapy (IMRT) trials in oropharyngeal cancer will be presented, and the role of this new modality of therapy in avoidance of xerostomia reviewed. S12 Functional results after treatment J. Olofsson *. Haukeland University Hospital, Norway Survival figures for especially advanced oropharyngeal carcinoma remain low despite modern treatment. Over all 5-year survival is in many studies reported to around 30%. A Finnish study by Makitie et al. (2006) reached 45%. Pfister et al. (1995) reported a 41% over all survival by induction chemotherapy with cisplatin and definitive radiotherapy. Kohno (2004) used induction chemotherapy followed by concurrent chemoradiotherapy in responders. Interstitial brachytherapy has also been recommended. However, Petruson et al. (2005) reported significant problems with dry mouth and swallowing of solid foods throughout a 3-year follow-up study in such patients. Parsons et al. (2002) recommended RT±ND for the majority of patients, especially focusing on functional consequences of treatment. Pourel et al. (2002) found significantly impaired QOL in longterm survivors, especially looking at psychosocial parameters. They stressed the role of coping processes. Woolley et al. (2005) did not see that deprivation was related to more advanced disease. Mehanna and Morton (2006) noted