Multidisciplinary approach in head and neck cancer

doi:10.31744/einstein_journal/2024EDS3

The state of the art in the management of the Head and Neck cancer is the multidisciplinary approach (MDA), preferably in a Tumor Board setting including not only Medical Doctors of several specialties (Head and Neck Surgeons, Otolaryngologists, Plastic Surgeons, Clinical and Radiation Oncologists, Radiologists and Pathologists, Endocrinologists and Nuclear Medicine Specialists, among others), but other health professionals (Speech Therapists, Nurses, Physical Therapists and Psychologists, among others) as well.(¹) However, it is important to emphasize that, in some less favored environments, there are some socioeconomic logistic restrains which may impair in real life the effective establishment of a truly MDA.(²)

The initial impact of the coordinated MDA is evident from the initial steps of the diagnosis. It is highly recommended to have a dedicated Head and Neck Radiology team, to offer the Health team a thorough imaging evaluation,(³) especially when a salvage procedure is required.(⁴,⁵)

Recently, the importance of the MDA in a Tumor Board setting has become very clear in the proper therapeutic decision process in some specific Head and Neck cancers. Following, there are some very eloquent examples of these tumors.

The therapeutic decisions of patients with HPV+ oropharyngeal cancers have been influenced by peculiarities of these tumors, very prevalent during the last 2 to 3 decades, especially in USA and Europe. Due to their marked chemoradiotherapy sensitivity, as well as to the development of less invasive transoral surgical approaches, like transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), there has been a trend to decrease the impact of the treatment morbidity, preserving the high levels of disease-free survival with good quality of life.(⁶-¹⁰) Another potential tool for the initial staging(¹¹) and post-treatment surveillance(¹²) is the dosage of human papillomavirus circulating tumor DNA in patients with HPV+ oropharyngeal cancers.

Another very important advancement offered by the MDA is the treatment of anaplastic thyroid cancer. This is one of the most lethal human malignant tumors, and the patient’s survival rarely exceeded one year. However, MDA in some referral centers in Europe and USA have opened a new therapeutic perspective for V600E+ undifferentiated thyroid carcinomas, offering a 2-year disease-free survival rate over 80% of the cases.(¹³-¹⁶)

Finally, patients with very advanced cutaneous squamous cell carcinoma of the Head and Neck present with a formidable therapeutic challenge, due to the involvement of vital parts of the central nervous system and of the orbit. The conventional surgical treatment usually leads to disfiguring craniofacial defects, reconstructed by complex free flaps, with significant morbidity and mortality.(¹⁷) Recently, MDA incorporating immunotherapy has added improved cure rates, decreased the surgical morbidity, and even obtaining long-term local control in patients previously considered inoperable.(¹⁸-²¹)

In summary, the increasing tendency of managing advanced cancers of the Head and Neck with MDA, usually in Tumor Boards, has resulted in improved disease-free survival results, with best functional outcomes and less aggressive operations.

REFERENCES

¹ Bossi P, Alfieri S. The Benefit of a Multidisciplinary Approach to the Patient Treated with (Chemo) Radiation for Head and Neck Cancer. Curr Treat Options Oncol. 2016;17(10):53-62.
² Pillay B, Wootten AC, Crowe H, Corcoran N, Tran B, Bowden P, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature. Cancer Treat Rev. 2016;42:56-72. Review.
³ Alterio D, Preda L, Volpe S, Giannitto C, Riva G, Kamga Pounou FA, et al. Impact of a dedicated radiologist as a member of the head and neck tumour board: a single-institution experience. Acta Otorhinolaryngol Ital. 2020;40(1):26-32.
⁴ Garcia MR, Passos UL, Ezzedine TA, Zuppani HB, Gomes RL, Gebrim EM. Postsurgical imaging of the oral cavity and oropharynx: what radiologists need to know. Radiographics. 2015;35(3):804-18.
⁵ Rohde M, Nielsen AL, Johansen J, Sϕrensen JA, Diaz A, Pareek M, et al. Upfront PET/CT affects management decisions in patients with recurrent head and neck squamous cell carcinoma. Oral Oncol. 2019;94:1-7.
⁶ Sinha P, Karadaghy OA, Doering MM, Tuuli MG, Jackson RS, Haughey BH. Survival for HPV-positive oropharyngeal squamous cell carcinoma with surgical versus non-surgical treatment approach: a systematic review and meta-analysis. Oral Oncol. 2018;86:121-31.
⁷ Ibrahim AS, Civantos FJ, Leibowitz JM, Thomas GR, Arnold DJ, Franzmann EJ, et al. Meta-analysis comparing outcomes of different transoral surgical modalities in management of oropharyngeal carcinoma. Head Neck. 2019;41(6):1656-66.
⁸ Campo F, Iocca O, De Virgilio A, Mazzola F, Mercante G, Pichi B, et al. Treatment of oropharyngeal squamous cell carcinoma: is swallowing quality better after TORS or RT? Radiother Oncol. 2023;183:109547.
⁹ Williamson A, Moen CM, Slim MA, Warner L, O’Leary B, Paleri V. Transoral robotic surgery without adjuvant therapy: a systematic review and meta-analysis of the association between surgical margins and local recurrence. Oral Oncol. 2023;147:106610. Review.
¹⁰ Gupta KK, De M, Athanasiou T, Georgalas C, Garas G. Quality of life outcomes comparing primary Transoral Robotic Surgery (TORS) with primary radiotherapy for early-stage oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis. Eur J Surg Oncol. 2024;50(7):108434.
¹¹ Karimi A, Jafari-Koshki T, Zehtabi M, Kargar F, Gheit T. Predictive impact of human papillomavirus circulating tumor DNA in treatment response monitoring of HPV-associated cancers; a meta-analysis on recurrent event endpoints. Cancer Med. 2023;12(17):17592-602.
¹² Campo F, Iocca O, Paolini F, Manciocco V, Moretto S, De Virgilio A, et al. The landscape of circulating tumor HPV DNA and TTMV-HPVDNA for surveillance of HPV-oropharyngeal carcinoma: systematic review and meta-analysis. J Exp Clin Cancer Res. 2024;43(1):215. Review.
¹³ Salehian B, Liem SY, Mojazi Amiri H, Maghami E. Clinical Trials in Management of Anaplastic Thyroid Carcinoma; Progressions and Set Backs: aSystematic Review. Int J Endocrinol Metab. 2019;17(1):e67759. Review.
¹⁴ Bulfamante AM, Lori E, Bellini MI, Bolis E, Lozza P, Castellani L, et al. Advanced Differentiated Thyroid Cancer: A Complex Condition Needing a Tailored Approach. Front Oncol. 2022;12:954759.
¹⁵ Zhou SY, Luo LX. An overview of the contemporary diagnosis and management approaches for anaplastic thyroid carcinoma. World J Clin Oncol. 2024;15(6):674-6.
¹⁶ Hamidi S, Dadu R, Zafereo ME, Ferrarotto R, Wang JR, Maniakas A, et al. Initial Management of BRAF V600E-Variant Anaplastic Thyroid Cancer: The FAST Multidisciplinary Group Consensus Statement. JAMA Oncol. 2024 Jul 11.
¹⁷ Cernea CR, Dias FL, Lima RA, Farias T, Mendonça UB, Vellutini E, et al. Atypical facial access: an unusually high prevalence of use among patients with skull base tumors treated at 2 centers. Arch Otolaryngol Head Neck Surg. 2007;133(8):816-9.
¹⁸ Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, Bataille V, Bastholt L, Dreno B, Concetta Fargnoli M, Forsea AM, Frenard C, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NWJ, Malvehy J, Del Marmol V, Middleton MR, Moreno-Ramirez D, Pellecani G, Peris K, Saiag P, van den Beuken-van Everdingen MH, Vieira R, Zalaudek I, Eggermont AM, Grob JJ; European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC). European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment. Eur J Cancer. 2020;128:83-102.
¹⁹ McLean LS, Lim AM, Webb A, Cavanagh K, Thai A, Magarey M, et al. Immunotherapy to Avoid Orbital Exenteration in Patients With Cutaneous Squamous Cell Carcinoma. Front Oncol. 2022;11:796197.
²⁰ Rodio M, Tettamanzi M, Trignano E, Rampazzo S, Serra PL, Grieco F, et al. Multidisciplinary Management of Cutaneous Squamous Cell Carcinoma of the Scalp: An Algorithm for Reconstruction and Treatment. J Clin Med. 2024;13(6):1581.
²¹ Bailly-Caillé B, Levard R, Kottler D, Dompmartin A, L’Orphelin JM. Long-term survival after anti-PD-1 discontinuation in advanced cutaneous squamous cell carcinoma (cSCC): a proof of concept of benefit of concomitant cemiplimab and radiotherapy. Cancer Immunol Immunother. 2024;73(7):118.

Publication Dates

Publication in this collection
15 Nov 2024
Date of issue
2024

This content is licensed under a Creative Commons Attribution 4.0 International License.

[1] ¹ Bossi P, Alfieri S. The Benefit of a Multidisciplinary Approach to the Patient Treated with (Chemo) Radiation for Head and Neck Cancer. Curr Treat Options Oncol. 2016;17(10):53-62.

[2] ² Pillay B, Wootten AC, Crowe H, Corcoran N, Tran B, Bowden P, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature. Cancer Treat Rev. 2016;42:56-72. Review.

[3] ³ Alterio D, Preda L, Volpe S, Giannitto C, Riva G, Kamga Pounou FA, et al. Impact of a dedicated radiologist as a member of the head and neck tumour board: a single-institution experience. Acta Otorhinolaryngol Ital. 2020;40(1):26-32.

[4] ⁴ Garcia MR, Passos UL, Ezzedine TA, Zuppani HB, Gomes RL, Gebrim EM. Postsurgical imaging of the oral cavity and oropharynx: what radiologists need to know. Radiographics. 2015;35(3):804-18.

[5] ⁵ Rohde M, Nielsen AL, Johansen J, Sϕrensen JA, Diaz A, Pareek M, et al. Upfront PET/CT affects management decisions in patients with recurrent head and neck squamous cell carcinoma. Oral Oncol. 2019;94:1-7.

[6] ⁶ Sinha P, Karadaghy OA, Doering MM, Tuuli MG, Jackson RS, Haughey BH. Survival for HPV-positive oropharyngeal squamous cell carcinoma with surgical versus non-surgical treatment approach: a systematic review and meta-analysis. Oral Oncol. 2018;86:121-31.

[7] ⁷ Ibrahim AS, Civantos FJ, Leibowitz JM, Thomas GR, Arnold DJ, Franzmann EJ, et al. Meta-analysis comparing outcomes of different transoral surgical modalities in management of oropharyngeal carcinoma. Head Neck. 2019;41(6):1656-66.

[8] ⁸ Campo F, Iocca O, De Virgilio A, Mazzola F, Mercante G, Pichi B, et al. Treatment of oropharyngeal squamous cell carcinoma: is swallowing quality better after TORS or RT? Radiother Oncol. 2023;183:109547.

[9] ⁹ Williamson A, Moen CM, Slim MA, Warner L, O’Leary B, Paleri V. Transoral robotic surgery without adjuvant therapy: a systematic review and meta-analysis of the association between surgical margins and local recurrence. Oral Oncol. 2023;147:106610. Review.

[10] ¹⁰ Gupta KK, De M, Athanasiou T, Georgalas C, Garas G. Quality of life outcomes comparing primary Transoral Robotic Surgery (TORS) with primary radiotherapy for early-stage oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis. Eur J Surg Oncol. 2024;50(7):108434.

[11] ¹¹ Karimi A, Jafari-Koshki T, Zehtabi M, Kargar F, Gheit T. Predictive impact of human papillomavirus circulating tumor DNA in treatment response monitoring of HPV-associated cancers; a meta-analysis on recurrent event endpoints. Cancer Med. 2023;12(17):17592-602.

[12] ¹² Campo F, Iocca O, Paolini F, Manciocco V, Moretto S, De Virgilio A, et al. The landscape of circulating tumor HPV DNA and TTMV-HPVDNA for surveillance of HPV-oropharyngeal carcinoma: systematic review and meta-analysis. J Exp Clin Cancer Res. 2024;43(1):215. Review.

[13] ¹³ Salehian B, Liem SY, Mojazi Amiri H, Maghami E. Clinical Trials in Management of Anaplastic Thyroid Carcinoma; Progressions and Set Backs: aSystematic Review. Int J Endocrinol Metab. 2019;17(1):e67759. Review.

[14] ¹⁴ Bulfamante AM, Lori E, Bellini MI, Bolis E, Lozza P, Castellani L, et al. Advanced Differentiated Thyroid Cancer: A Complex Condition Needing a Tailored Approach. Front Oncol. 2022;12:954759.

[15] ¹⁵ Zhou SY, Luo LX. An overview of the contemporary diagnosis and management approaches for anaplastic thyroid carcinoma. World J Clin Oncol. 2024;15(6):674-6.

[16] ¹⁶ Hamidi S, Dadu R, Zafereo ME, Ferrarotto R, Wang JR, Maniakas A, et al. Initial Management of BRAF V600E-Variant Anaplastic Thyroid Cancer: The FAST Multidisciplinary Group Consensus Statement. JAMA Oncol. 2024 Jul 11.

[17] ¹⁷ Cernea CR, Dias FL, Lima RA, Farias T, Mendonça UB, Vellutini E, et al. Atypical facial access: an unusually high prevalence of use among patients with skull base tumors treated at 2 centers. Arch Otolaryngol Head Neck Surg. 2007;133(8):816-9.

[18] ¹⁸ Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, Bataille V, Bastholt L, Dreno B, Concetta Fargnoli M, Forsea AM, Frenard C, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NWJ, Malvehy J, Del Marmol V, Middleton MR, Moreno-Ramirez D, Pellecani G, Peris K, Saiag P, van den Beuken-van Everdingen MH, Vieira R, Zalaudek I, Eggermont AM, Grob JJ; European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC). European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment. Eur J Cancer. 2020;128:83-102.

[19] ¹⁹ McLean LS, Lim AM, Webb A, Cavanagh K, Thai A, Magarey M, et al. Immunotherapy to Avoid Orbital Exenteration in Patients With Cutaneous Squamous Cell Carcinoma. Front Oncol. 2022;11:796197.

[20] ²⁰ Rodio M, Tettamanzi M, Trignano E, Rampazzo S, Serra PL, Grieco F, et al. Multidisciplinary Management of Cutaneous Squamous Cell Carcinoma of the Scalp: An Algorithm for Reconstruction and Treatment. J Clin Med. 2024;13(6):1581.

[21] ²¹ Bailly-Caillé B, Levard R, Kottler D, Dompmartin A, L’Orphelin JM. Long-term survival after anti-PD-1 discontinuation in advanced cutaneous squamous cell carcinoma (cSCC): a proof of concept of benefit of concomitant cemiplimab and radiotherapy. Cancer Immunol Immunother. 2024;73(7):118.