Lawrence Han Hwee Quek1,2, Ming Yann Lim3,4,5, Timothy Cheo6,7, Hui Lin Teo3,8, Uei Pua9,5. 1. Department of Diagnostic Radiology, Tan Tock Seng Hospital, Basement 1, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. lawrence_quek@ttsh.com.sg. 2. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. lawrence_quek@ttsh.com.sg. 3. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. 4. Department of Otorhinolaryngology and Head and Neck Surgery, Tan Tock Seng Hospital, Singapore, Singapore. 5. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 6. Department of Radiation Oncology, Tan Tock Seng Hospital, Singapore, Singapore. 7. Department of Radiation Oncology, National University Health System, Singapore, Singapore. 8. Department of Medical Oncology, Tan Tock Seng Hospital, Singapore, Singapore. 9. Department of Diagnostic Radiology, Tan Tock Seng Hospital, Basement 1, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
Abstract
PURPOSE OF REVIEW: In this review, we will outline the role of percutaneous interventional radiological management of recurrent head and neck (H&N) cancer in the context of a multidisciplinary setting which consists of surgery, radiation therapy, as well as established and evolving systemic therapies that may impact current practice. RECENT FINDINGS: Management of recurrent H&N cancer is complex, with attention to the preservation of function and minimal treatment-related morbidity. The favored treatment modalities in local recurrence previously treated with radiotherapy are surgical resection, and if unresectable, for chemotherapy as definitive treatment, or as a prelude to resection if there is good tumor response. Unfortunately, some of these patients are too frail for major surgery or to withstand the toxicity of chemotherapy. There is a gap for effective local therapy without the morbidity of surgery, toxicity of re-irradiation, and systemic side effects of chemotherapy. Percutaneous interventions have the potential to bridge that gap as well as provide palliative symptomatic treatment for patients that have exhausted all treatment options. In the multidisciplinary setting involving the treatment of complex recurrent H&N cancer, percutaneous management now plays a viable and effective role with a foothold in this team-based approach.
PURPOSE OF REVIEW: In this review, we will outline the role of percutaneous interventional radiological management of recurrent head and neck (H&N) cancer in the context of a multidisciplinary setting which consists of surgery, radiation therapy, as well as established and evolving systemic therapies that may impact current practice. RECENT FINDINGS: Management of recurrent H&N cancer is complex, with attention to the preservation of function and minimal treatment-related morbidity. The favored treatment modalities in local recurrence previously treated with radiotherapy are surgical resection, and if unresectable, for chemotherapy as definitive treatment, or as a prelude to resection if there is good tumor response. Unfortunately, some of these patients are too frail for major surgery or to withstand the toxicity of chemotherapy. There is a gap for effective local therapy without the morbidity of surgery, toxicity of re-irradiation, and systemic side effects of chemotherapy. Percutaneous interventions have the potential to bridge that gap as well as provide palliative symptomatic treatment for patients that have exhausted all treatment options. In the multidisciplinary setting involving the treatment of complex recurrent H&N cancer, percutaneous management now plays a viable and effective role with a foothold in this team-based approach.
Entities:
Keywords:
Ablation; Chemotherapy; Cryoablation; Head and neck cancer; Immunotherapy; Radiation therapy; Salvage surgery; Squamous cell carcinoma
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