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1、HeadandNeckCancerandtheRoleofRadiotherapyPresentedby:AdamS.GardenM.D.CancerIncidenceAllCancers1,252,000Lung170,000Breast183,000Colo-rectal138,000HeadandNeck40,000Cervical/Endometrium38,000Hodgkin’sDisease8,000CancerdeathsAllCancers547,000Lung157,000Breast46,0
2、00Colo-rectal55,000HeadandNeck12,000Cervical/Endometrium12,000Hodgkin’sDisease1,500Sitesofdiseasemultiplesitesincloseproximity-differentmanagementoralcavitypharynx(naso-,oro,hypo)larynx(supraglottis,glottis)others(sinus,salivaryglands)PathologyMajoritySquamou
3、scellcarcinoma(liningofUADT)Othercarcinomas(neuroendocrine,adenoCa,adenoidcysticCa,MucoepidermoidCa)andmalignancies(lymphoma,sarcoma)unusualEpidemiologyMalesTobaccoAlcoholGERD(larynx),HPV(oropharynx), EBV(nasopharynx)PatternsofSpreadOrderlypatternofspreadPrim
4、arytumor(T)nodes(N)distantmetastases(M)<10%presentwithdistantdiseaseHighincidenceofcomorbidityand2ndprimarytumorsSymptomsHoarsenessOtalgiaSorethroatOdynaphagiaDysphagiaTrismusAsymptomaticlymphadenopathyhearinglosscranialneuropathiesIllfittingdenturesWork-upHi
5、storyandphysicalFiberopticendocscopyLabworkandchestx-rayDirectlaryngoscopy(tripleendoscopy)Biopsyand/orfineneedleaspirateTreatmentphilosophyEarlydiseaseoftenmanagedwithsinglemodalityChoiceofmodalitybasedonoutcomesandmorbidityAdvanceddiseasetreatedwith2or3moda
6、litiesCombiningSurgeryandRadiationPreoperativeradiationPostoperativeradiationDefinitiveradiationtotheprimary;combinedsurgeryandradiationtotheneckChemotherapyforheadandneckcancerInductiontherapy-numerousstudies,noclearbenefit,rolestillbeingdefinedAdjuvantthera
7、py-nosurvivalimprovement;mayreduceDM;hardtoadministerConcurrentchemoradiation-multiplestudiesshowimprovedoutcomescomparedtoradiationaloneRoleofradiationforheadandneckcancerDefinitiveAdjuvantPalliativeIndicationsforpostoperativeXRTInadequatemarginsPerineuralin
8、vasionT4diseaseHighgradeMultiplenodesExtracapsularorsofttissueextensionNeckanatomyNecknodesUpperjugularnode,necroticcenterPosteriorcervicalnodesNeckMetastasesMostsiteshaveaccesstothelymph
