Cancers of the Head and Neck: Advances in Surgical Therapy, Radiation Therapy and Chemotherapy

Cancers of the head and neck are among the most morbid of cancers. Convention­ al surgery and/or radiation therapy have a high cure rate for patients with early stage disease. However, despite optimal treatment with surgery and radiotherapy, patients with nodal spread or extensive local disease have a low cure rate. Even if a cancer is cured, a patient is often left with long-term debilities from the treatment and/or cancer. The major causes for decreased survival in patients with advanced head and neck cancer include local recurrence, distant metastases, and second primaries. All of these need to be addressed if one is to improve upon the curability of advanced disease. There are several new techniques, surgical and radiotherapeutic, designed to improve local control. Brachytherapy, or interstitial implantation, delivers a high dose of localized radiation with minimal normal tissue injury. This technique as discussed by Goffinet, may be even more efficacious when combined with hyperthermia. New, creative methods of radiation therapy delivery, such as the use of multiple fractions per day, as discussed by Parsons and Million, are also contributing to long-term local control. Laser therapy, discussed by Ossoff and Nemeroff, provides another tool for treatment of local disease.