CONSERVATION THERAPY IN PATIENTS WITH HEAD AND NECK-CARCINOMA

Head and neck cancer represents 3.6 to 5% of all malignancies in the U nited States. However, the potential functional, cosmetic and psycholo gical repercussions, resulting from treatment of this disease signific antly impacts the patient's quality of life. A coordinated multidiscip linary team approach for the treatment and follow-up of head and neck cancer patients is crucial for optimal patient management. Standard th erapy of early (stage I or II) head and neck cancers consists of radia tion alone or surgical resection. Five-year survival statistic for the se patients range from 60 to 95%. For advanced cancers (stage III or I V), standard therapy is comprised of surgery plus radiation therapy. T he surgical defects are often difficult to rehabilitate. The 5-year su rvival statistics range from 10 to 60%, depending on the site, but are usually less than 30%. In an effort to improve survival and reduce th e need for extensive surgical resections, researchers have utilized in duction chemotherapy in several randomized trials for patients with ad vanced head and neck can cer. Although not been shown to improve survi val, induction chemotherapy has played a role in organ preservation as a part of combined modality program for patients with advanced diseas e. Conservation surgical techniques involve mandible-sparing procedure s, laryngeal preservation surgeries and selective or 'functional' neck dissections. Free-tissue transfer using microvascular techniques has dramatically increased the surgeon's reconstructive armamentarium. Pat ients are experiencing more functional and cosmetic outcomes despite e xtensive cancer resections. Finally, concomitant chemoradiotherapy has emerged as one of the most promising treatment approaches for patient s with advanced stage head and neck cancer. Studies show trends toward improved survival with preservation of organ and function in patients with this devastating disease.