Our Treatment Approach

Head and Neck Cancers

Dual Approach to Care
Pioneering Surgical Techniques
Targeted Radiation: Sparing Healthy Tissue
The Role of Chemotherapy
Reaching Out With New Media

Dual Approach to Care
The treatment of head and neck cancers has a dual focus: eliminating the cancer and providing the latest reconstructive procedures to restore patients’ appearance and ability to communicate and swallow. Siteman Cancer Center physicians have developed a number of these reconstructive procedures, including tongue, facial soft-tissue, voice and skull-base reconstruction.

Siteman’s head and neck cancer program can provide these broad-based treatments because of its strong multidisciplinary approach. The team includes specialists in otolaryngology, radiation oncology, medical oncology, radiology, pathology, dentistry, oral surgery, speech therapy, psychology and dietetics.

Pioneering Surgical Techniques
Siteman surgeons offer leading-edge treatments both in removal and reconstruction. In the area of tumor removal, they use minimally invasive techniques such as transoral laser microsurgery for cancers of the larynx and pharynx. The technique allows them to remove tumors through the mouth without opening the patient’s neck, unless they also need to remove lymph nodes. This form of therapy has markedly reduced side effects and hospital lengths of stay.

In the area of reconstruction, Siteman surgeons have pioneered a technique to rebuild the tongue after a large portion of it has been lost to cancer surgery. Using tissue from other parts of the body – a procedure known as microvascular free-tissue transfer – they create a structure that functions somewhat like a tongue and helps patients eat, chew, swallow and speak more normally following surgery.

For patients who had part of their larynx, or voice box, removed, our surgeons specialize in voice-box reconstruction. They rebuild the vocal mechanism, often by using additional tissue to create a new vocal cord.

When any portion of the face – lips, cheeks, forehead or nose – is affected by cancer and needs to be removed, it is disfiguring for patients. One option is to develop a prosthesis, or artificial replacement. Siteman’s head and neck cancer team includes a prosthodontist, a dentist who specializes in making replacements for teeth and other facial structures. Another option is tissue reconstruction. Our surgeons use a free-tissue transfer of bone and skin to reconstruct the area. The goal is to create something that will work well with surrounding structures, provide maximum function and look natural.

Targeted Radiation: Sparing Healthy Tissue
Depending on how advanced it is, head and neck cancer may be treated with surgery or radiation therapy or a combination of both. In some instances, chemotherapy may be added. When radiation therapy is needed, patients benefit from Siteman’s experience as a world leader in treating head and neck cancers with intensity-modulated radiation therapy (IMRT), which allows physicians to conform radiation to the shape of a tumor and even modulate treatment to match the tumor’s densities. Since 1997, IMRT has been used in more than 300 cases at Siteman.

Our radiation oncologists have recently been involved in several important clinical trials testing the usefulness of IMRT. One is aimed at studying the troublesome problem of dry mouth, which results from radiation damage to the salivary glands. Preliminary data in this study shows that IMRT can substantially spare the glands and preserve patients’ eating and drinking functions.

A second trial uses functional PET imaging to assess whether a tumor will respond to radiation or will need to be surgically removed based on its level of oxygenation. A tumor with a low level of oxygen is more resistant to radiation and chemotherapy, while a tumor with sufficient oxygen may respond better to radiation and not require surgery.

The Role of Chemotherapy
Over the past five years, clinical trials have shown that adding chemotherapy or epidermal grown factor receptor (EGFR) inhibitors to standard therapy clearly benefits patients with locally advanced cancers of the squamous cells that line the passages of the respiratory tract. The latest studies in which chemotherapy was added to radiation therapy showed a survival benefit of about 12 percent more than when radiation was used alone.

Members of the head and neck cancer team currently are participating in a national study testing whether patients with locally advanced head and neck cancers would benefit from a standard chemotherapy drug combined with another, Taxotere, before undergoing simultaneous chemotherapy and radiation therapy.