gms | German Medical Science

For the first time in several decades we have devoted a complete volume of 9 articles to the topic of head and neck cancer. In over 90 years our society has frequently dealt with various aspects of head and neck cancer. Our aim now is to present a current overview of cancer genesis, diagnosis and treatment strategies, quality of life and organ function.

Research developments in genetics have given us an increased understanding of the genesis of cancer, including processes like cell division, cell growth and apoptosis. This has led to the development of a number of new protocols for chemotherapy as well as “small molecules” and antibodies designed to influence cancer development and metastasis. Our understanding is still limited, however, and further advances may be expected in the future. Perhaps individualized treatment may one day be achieved, “custom fit” for cell signal pathways in certain tissues with characteristic patterns of metastasis. In some cases, signal pathways are already being used to explain resistence to chemotherapeutic agents and to choose alternative substances. The articles provide an overview of important current research results.

Developments in chemoradiation have required the critical reassessment of surgical techniques as well. Surgical treatment has made marked advances in terms of organ function and quality of life in the last 20 years. This has been due, in large part, to the advent of transoral laser surgery as propagated by Wolfgang Steiner and Heinrich Rudert. Classic open surgery has also been refined, especially through the use of innovative reconstructive techniques. However, large, multi-center studies today are conducted almost exclusively for medical cancer treatment and are often associated with the licensing of new agents. Studies comparing surgical treatment to chemoradiation or bioradiation are very difficult to conduct for ethical and technical reasons and are almost non existent for head and neck cancer. Improvements in radiation results are often associated with developments in medical treatment. Bioradiation has increasingly become established, utilizing small molecules and antibodies. Changes in current protocols involving fractionation, intensity modulatation (IMRT), and the use of particles or ionizing radiation, have led to favourable results in the treatment of head and neck cancer.

For years the standard protocol for non-resectable head and neck cancer has been simultaneous chemoradiation with platin based agents. In recent years induction protocols with TPF (Docetaxel, Cisplatin, 5-Fluorouracil) and treatment with antibodies have been developed in multi-center studies. These may help select a subset of cancer patients that will benefit most from treatment with these agents. Whether or not dosage reduction is possible for the treatment of certain cancer types, for example those associated with HPV, is not yet clear. These developments require a new assessment of the role of primary surgey in head and neck cancer treatment and will be addressed in the following articles.

The success of cancer treatment should not only be measured in terms of overall survival or progression free intervals, but also in terms of subjective quality of life and the preservation of organ function, as assessed by the treating physician. Organ preservation is in and of itself not necessarily desirable, if function can not be preserved as well. Thus early toxicity, mucositis and myelotoxicity caused by chemotherapy must be considered as well as late toxicity due to radiation, which can lead to dysphagia, speech impairment and nerve dysfunction. Studies are required to assess the benefit of primary surgery in the preservation of organ function in the future. Because of the increased complexity of cancer treatment, otolaryngologists and head and neck surgeons (surgical oncologists) will need to become increasingly familiar with side effects of chemoradiation in the future, if we wish to retain our strategic position in the management of head and neck cancer.

It is my hope that this collection of articles will be stimulating and perhaps of some lasting importance, even if it can only present the current state of the art concerning head and neck cancer. I would like to express my deep appreciation to all contributing authors for their extensive work.

Prof. Dr. med. Norbert Stasche

Past President of the German Society of ORL HNS

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