Expert Sheds Light on Investigative Surgical Approaches in Head and Neck Cancer

Minimally invasive approaches are being explored to lower associated adverse events and, overall, improve patient outcomes for patients with head and neck cancer.
BY Danielle Bucco
PUBLISHED May 03, 2017
Amid the increasing variety of treatments available for patients with head and neck cancer, surgical oncologists are also exploring more minimally invasive approaches to lower associated adverse events and, overall, improve patient outcomes.

“If we could incorporate surgery, either endoscopic laser surgery or transoral robotic surgery, in order to minimize or reduce the treatments that might have side effects, that is going to be beneficial,” said Benjamin L. Judson, M.D.

In an interview with CURE, Judson, an associate professor of surgery at Yale School of Medicine, highlights the importance of a multidisciplinary team and shares insight on some of the advancements related to surgery for patients with head and neck cancer.

What are the benefits of having a multidisciplinary team?

Head and neck cancer is one of those diseases where the treatments are multidisciplinary. For some patients, the most beneficial treatment might involve surgery, whereas for others it does not. Similarly, some patients are going to benefit from radiation or chemotherapy instead of surgery. Having each of those perspectives present while discussing a case is important in terms of coming up with a treatment that will be beneficial for an individual.

How do you determine if a patient should receive surgery over other forms of treatment?

In many cases, the evidence makes it straightforward as to what the best treatment option is, whether it be surgery followed by radiation or whether it’s radiation therapy only. There are always specific factors for each patient that might make receiving one form of treatment more difficult or riskier than others.

Some patients might not be able to get radiation because of a disease that they have or because of prior treatments, when radiation would normally be the standard of treatment for that patient. Similarly, with chemotherapy, some are unable to receive it because of a medical condition that they have. In terms of surgery, some might not be healthy enough to undergo surgery, which makes it important to discuss the specifics of individual cases.

What are some of the most prominent recent advancements that have been made?

In head and neck cancers, there are a few major changes that are happening. Even in my short 15 years, there has been this rise of human papillomavirus (HPV)-associated cancers. It’s distinct from the disease that we have taken care of before.

Additionally, there has been surgical advances in terms of different ways to provide minimally invasive surgery for patients. Currently, people are unsure what the best treatments are. There are clinical trials underway and, hopefully, in a few years we will begin to know more about what the best treatment is based on evidence, but we are not there yet.

What impact has minimally invasive surgery had on the patient population?

In my opinion, the impact of minimally invasive surgery is based on whether you can use it judiciously and balance it with the other treatments that are available. For patients with whom the prognosis is already excellent, we are trying to minimize the treatment and the treatment side effects. If we could incorporate surgery, either endoscopic laser surgery or transoral robotic surgery, in order to minimize or reduce the treatments that might have side effects, that is going to be beneficial. One really needs to be thoughtful about if surgery is going to fit in with the other treatments that are needed.

What challenges would you like to see tackled regarding surgery for patients with head and neck cancer?

In terms of minimally invasive surgery in head and neck tumors there are two areas where there is going to be changes in the years ahead. One change is involving technologically. There are new developments coming down the pipeline that will affect what we can do with surgery and how it’s done. In my opinion, what is more important is starting to get back data from trials that will allow us to make evidence-based decisions and recommendations about how to use this tool.

Are there any ongoing trials that you’re particularly excited to see the results of?

ECOG-3311 is an open trial that we’re hopefully getting close to seeing data. In that trial patients with HPV-positive disease are going to receive minimally invasive surgery and, if their pathology report is low risk, they go into the observation arm. If the report is high-risk they get the standard treatment, which is chemotherapy and radiation. If they demonstrate an intermediate-risk stage, the patients will be randomized to either standard radiation or lower-dose radiation.

In all of the arms, there are multiple quality-of-life functional outcome measures, which is a great advancement to have. Surgery is frequently used in the treatment of head and neck cancer, it’s important and unique to have a trial like this that involves surgery because there have not been many surgery-based trials in the past.
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