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Multimodality Treatment in Recurrent Metastatic Head and Neck Cancer

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (31 August 2023) | Viewed by 4285

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Special Issue Editor

Dr. Giovanni Salzano

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Guest Editor

Maxillo-Facial and ENT Surgery Unit, INT-IRCCS "Fondazione G. Pascale", 80131 Naples, Italy
Interests: head and neck cancer; reconstructive surgery; endoscopic surgery; virtual surgical planning; CAD/CAM; implantology; facial surgery; traumatology
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Special Issue Information

Dear Colleagues,

Tumors of the head–neck area are a widely heterogeneous category of neoplasms containing extremely different diseases in terms of histology, genetics and clinical behavior. We can generally identify two main types/categories of neoplasms in the head–neck area, namely: (1) tumors originating from the pharynx, oral cavity and larynx (generally but not always with squamous histology); and (2) tumors of the major/minor salivary glands.

From the prognostic point of view, for both the categories of neoplasms (1 and 2), it is possible to clearly distinguish locoregional diseases from advanced ones. In general, it is possible to say that the prognosis of locoregional neoplasms subjected to appropriate oncological therapy is clearly better, in terms of global survival and disease-free survival, compared to that related to advanced diseases (relapsing after primary treatment and/or metastatic).

It is essential in patients diagnosed with head and neck cancer in an advanced stage to prepare a treatment that, in addition to its effectiveness, also takes into account its activity, which is measured in terms of the percentage of patients who undergo debulking after treatment.

In recent years, the clinical approach to the patient has changed considerably, even as regards the patient with advanced disease that, until 5–10 years ago, was considered incurable and destined for a severe prognosis. In fact, the multidisciplinary approach and the addition of locoregional therapies (palliative surgery and/or radiotherapy for cytoreductive purposes and/or electrochemotherapy), symptomatic therapies (analgesic therapy, bisphosphonates/denosumab) and above all early and immediate classification of adequate nutritional intake, to standard systemic therapies of head–neck neoplasms, has considerably improved the quality of life and in some scientific reports also the survival of patients with advanced disease.

The rationale behind this issue is to demonstrate that an adequate "additional" therapy, namely locoregional, symptomatic and, above all, nutritional, is able to improve not only the quality of life but also the objective response and the overall survival to specific cancer therapy, increasing the "anticancer" immune response and the patient's compliance with cancer treatment, allowing the clinician to maintain a fair "dose intensity" of the drug/anticancer drugs.

You may choose our Joint Special Issue in Current Oncology.

Dr. Giovanni Salzano
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

recurrent
metastatic
multimodality treatment
surgery
radiation therapy
chemotherapy
metabolism
quality of life
immunotherapy
target therapy

Published Papers (3 papers)

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Research

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13 pages, 1134 KiB

Open AccessArticle

Determining the Effectiveness of Fibrin Sealants in Reducing Complications in Patients Undergoing Lateral Neck Dissection (DEFeND): A Randomised External Pilot Trial

by Mandeep S. Bajwa, Richard Jackson, Jagtar Dhanda, Catrin Tudur Smith, Richard J. Shaw and Andrew G. Schache

Cancers 2023, 15(20), 5073; https://doi.org/10.3390/cancers15205073 - 20 Oct 2023

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Abstract

Objectives: High-quality randomised controlled trials (RCT) to support the use of Fibrin Sealants (FS) in neck dissection (ND) are lacking. The DEFeND trial assessed critical pilot/feasibility questions and signals from clinical outcomes to inform a future definitive trial. Patients and Methods: The study design piloted was a blinded surgical RCT. All participants underwent unilateral ND for head and neck cancer. Interventional arm: ND with application of FS. Control arm: ND alone. Feasibility outcomes included recruitment, effectiveness of blinding, protocol adherence and evaluating administrative processes. Clinical outcomes included surgical complications (primary outcome), drainage volume, time to drain removal, length of hospital stay, pain and the Neck Dissection Impairment Index. Results: Recruitment completed ahead of time. Fifty-three patients were recruited, and 48 were randomised at a rate of 5.3 patients/month. Blinding of patients, research nurses and outcome assessors was effective. Two protocol deviations occurred. Two patients were lost to follow-up. The mean (SD) Comprehensive Complication Index in the interventional arm was 6.5 (12.8), and it was 9.9 (14.2) in the control arm. The median (IQR) time to drain removal (days) was shorter in the interventional arm (2.67 (2.42, 3.58) vs. 3.40 (2.50, 4.27)). However, this did not translate to a clinically significant reduction in median (IQR) length of hospital stay in days (intervention: 3.48 (2.64, 4.54), control: 3.74 (3.11, 4.62)). Conclusion: The proposed trial design was effective, and a definitive surgical trial is feasible. Whilst there was a tendency for FS to improve clinical outcomes, the effect size did not reach clinical or statistical significance. (ISRCTN99181100). Full article

(This article belongs to the Special Issue Multimodality Treatment in Recurrent Metastatic Head and Neck Cancer)

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11 pages, 1597 KiB

Open AccessArticle

Salvage High-Dose-Rate Interventional Radiotherapy (Brachytherapy) Combined with Surgery for Regionally Relapsed Head and Neck Cancers

by Tamer Soror, Justina Paul, Corinna Melchert, Christian Idel, Dirk Rades, Karl-Ludwig Bruchhage, György Kovács and Anke Leichtle

Cancers 2023, 15(18), 4549; https://doi.org/10.3390/cancers15184549 - 14 Sep 2023

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Abstract

(1) Background: to report on the use of high-dose-rate (HDR) interventional radiotherapy (brachytherapy, IRT) as a salvage treatment for patients with regionally relapsed head and neck cancers. (2) Methods: A retrospective study of 60 patients treated with HDR-IRT for loco-regionally relapsed head and neck cancers at our institution (2016–2020). Treatment procedure, results, and related toxicities were collected. Local and overall survival outcomes were analyzed. (3) Results: The median follow-up was 22.4 months. Twenty-nine (48.3%) patients had locoregional recurrences with a median time of 28.9 months. The local-recurrence free-survival was 88.1% and 37.3% at 3 years and 5 years. At the last follow-up, 21 patients were alive and the median time to death was 24 months. The overall survival was 39.2% and 16.6% at 3 years and 5 years. Collectively, there were 28 events of grade ≥ 3 late toxicities recorded in 21 patients (35%). (4) Conclusions: Salvage HDR-IRT combined with surgery offers a second-line curative treatment option for regionally relapsed head and neck cancers with acceptable outcomes and toxicities. Full article

(This article belongs to the Special Issue Multimodality Treatment in Recurrent Metastatic Head and Neck Cancer)

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Review

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12 pages, 1264 KiB

Open AccessReview

Impact of Epstein Barr Virus Infection on Treatment Opportunities in Patients with Nasopharyngeal Cancer

by Francesco Perri, Francesco Sabbatino, Alessandro Ottaiano, Roberta Fusco, Michele Caraglia, Marco Cascella, Francesco Longo, Rosalia Anna Rega, Giovanni Salzano, Monica Pontone, Maria Luisa Marciano, Arianna Piccirillo, Massimo Montano, Morena Fasano, Fortunato Ciardiello, Giuseppina Della Vittoria Scarpati and Franco Ionna

Cancers 2023, 15(5), 1626; https://doi.org/10.3390/cancers15051626 - 6 Mar 2023

Cited by 2 | Viewed by 2184

Abstract

Chemical, physical, and infectious agents may induce carcinogenesis, and in the latter case, viruses are involved in most cases. The occurrence of virus-induced carcinogenesis is a complex process caused by an interaction across multiple genes, mainly depending by the type of the virus. Molecular mechanisms at the basis of viral carcinogenesis, mainly suggest the involvement of a dysregulation of the cell cycle. Among the virus-inducing carcinogenesis, Epstein Barr Virus (EBV) plays a major role in the development of both hematological and oncological malignancies and importantly, several lines of evidence demonstrated that nasopharyngeal carcinoma (NPC) is consistently associated with EBV infection. Cancerogenesis in NPC may be induced by the activation of different EBV “oncoproteins” which are produced during the so called “latency phase” of EBV in the host cells. Moreover, EBV presence in NPC does affect the tumor microenvironment (TME) leading to a strongly immunosuppressed status. Translational implications of the above-mentioned statements are that EBV-infected NPC cells can express proteins potentially recognized by immune cells in order to elicit a host immune response (tumor associated antigens). Three immunotherapeutic approaches have been implemented for the treatment of NPC including active, adoptive immunotherapy, and modulation of immune regulatory molecules by use of the so-called checkpoint inhibitors. In this review, we will highlight the role of EBV infection in NPC development and analyze its possible implications on therapy strategies. Full article

(This article belongs to the Special Issue Multimodality Treatment in Recurrent Metastatic Head and Neck Cancer)

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