Preservation of organ function in head and neck cancer

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Abstract

Preservation of function is a crucial aspect for the evaluation of therapies applied in the field of head and neck cancer. However, preservation of anatomic structures cannot automatically be equated with preservation of function. Functional outcome becomes increasingly important particularly for the evaluation of alternative treatment options with equivalent oncological outcomes.

As a result, present studies take into account three topic areas with varying emphasis: (1) the effects of cancer therapy on essential physiological functions, (2) additional therapy-induced side-effects and complications, and (3) health-related quality of life.

The present article summarizes vital aspects of clinical research from recent years. Functional outcomes after surgical and non-surgical treatment approaches are presented according to tumor localization and staging criteria. Additional methodological aspects relating to data gathering and documentation as well as challenges in implementing the results in clinical practice are also discussed.

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Most cited references 183

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ICF linking rules: an update based on lessons learned.

Alarcos Cieza, Szilvia Geyh, Somnath Chatterji … (2005)

Outcome research seeks to understand the end results of health services. Researchers use a wide variety of outcome measures including technical, clinical and patient-oriented measures. The International Classification of Functioning, Disability and Health (ICF) as a common reference framework for functioning may contribute to improved outcome research. The objective of this paper is to provide an updated version of the linking rules published in 2002 and illustrate how these rules are applied to link technical and clinical measures, health-status measures and interventions to the ICF. Three specific linking rules have been established to link health-status measures to the ICF and one specific linking rule has been created to link technical and clinical measures and interventions. A total of 8 linking rules have been established for use with all different outcome measures and with interventions. The newly updated linking rules will allow researchers systematically to link and compare meaningful concepts contained in them. This should prove extremely useful in selecting the most appropriate outcome measures among a number of candidate measures for the applied interventions. Further possible applications are the operationalization of concrete ICF categories using specific measures or the creation of ICF category-based item bankings.

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A penetration-aspiration scale.

J C Rosenbek, J Robbins, E B Roecker … (1996)

The development and use of an 8-point, equal-appearing interval scale to describe penetration and aspiration events are described. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled. Intra- and interjudge reliability have been established. Clinical and scientific uses of the scale are discussed.

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Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer.

J Pignon, J. Bourhis, C Domenge … (2000)

Despite more than 70 randomised trials, the effect of chemotherapy on non-metastatic head and neck squamous-cell carcinoma remains uncertain. We did three meta-analyses of the impact of survival on chemotherapy added to locoregional treatment. We updated data on all patients in randomised trials between 1965 and 1993. We included patients with carcinoma of the oropharynx, oral cavity, larynx, or hypopharynx. The main meta-analysis of 63 trials (10,741 patients) of locoregional treatment with or without chemotherapy yielded a pooled hazard ratio of death of 0.90 (95% CI 0.85-0.94, p<0.0001), corresponding to an absolute survival benefit of 4% at 2 and 5 years in favour of chemotherapy. There was no significant benefit associated with adjuvant or neoadjuvant chemotherapy. Chemotherapy given concomitantly to radiotherapy gave significant benefits, but heterogeneity of the results prohibits firm conclusions. Meta-analysis of six trials (861 patients) comparing neoadjuvant chemotherapy plus radiotherapy with concomitant or alternating radiochemotherapy yielded a hazard ratio of 0.91 (0.79-1.06) in favour of concomitant or alternating radiochemotherapy. Three larynx-preservation trials (602 patients) compared radical surgery plus radiotherapy with neoadjuvant chemotherapy plus radiotherapy in responders or radical surgery and radiotherapy in non-responders. The hazard ratio of death in the chemotherapy arm as compared with the control arm was 1.19 (0.97-1.46). Because the main meta-analysis showed only a small significant survival benefit in favour of chemotherapy, the routine use of chemotherapy is debatable. For larynx preservation, the non-significant negative effect of chemotherapy in the organ-preservation strategy indicates that this procedure must remain investigational.

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Author and article information

Journal

Journal ID (nlm-ta): GMS Curr Top Otorhinolaryngol Head Neck Surg

Journal ID (iso-abbrev): GMS Curr Top Otorhinolaryngol Head Neck Surg

Journal ID (publisher-id): GMS Curr Top Otorhinolaryngol Head Neck Surg

Title: GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery

Publisher: German Medical Science GMS Publishing House

ISSN (Electronic): 1865-1011

Publication date (Electronic): 20 December 2012

Publication date Collection: 2012

Volume: 11

Electronic Location Identifier: Doc07

Affiliations

[1 ]Clinic for Otorhinolaryngology, Ludwig Maximilians University (LMU) Munich, Munich, Germany

Author notes

*To whom correspondence should be addressed: Uta Tschiesner, Clinic for Otorhinolaryngology, Ludwig Maximilians University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany, Phone: +49 89-7095-0, E-mail: Uta.Tschiesner@ 123456med.uni-muenchen.de

Article

Publisher ID: cto000089 Publisher Item ID: Doc07 Other ID: urn:nbn:de:0183-cto0000898

DOI: 10.3205/cto000089

PMC ID: 3544204

PubMed ID: 23320059

SO-VID: 41d3d6fe-95ee-4a8e-a55b-2fb399a1986a

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/). You are free to copy, distribute and transmit the work, provided the original author and source are credited.

Preservation of organ function in head and neck cancer

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Karger: Oncology

Most cited references 183

ICF linking rules: an update based on lessons learned.

A penetration-aspiration scale.

Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer.

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