Hospital Heliopolis, Brazil
Title: The change of paradigm in initial therapy of head neck cancer
Otavio Alberto Curioni works in Hospital Heliopolis, Brazil.
Introduction: Due to advances in surgical techniques, radiotherapy and chemotherapy, there has been constant changes in the initial management of early and advanced head and neck cancer. Objective: To evaluate paradigm changes along the time. Data Synthesis: Surgery evolved rapidly from the improvement in anesthetic techniques, antibiotics, blood replacement, new reconstruction procedures, management strategies of neck metastasis and laryngeal cancer. Recognized as an eff ective staging and therapeutic procedure, elective neck dissection diminished functional and aesthetic sequelae. Partial laryngectomies and endoscopic transoral laser resection could keep the function of speech and swallowing without defi nitive tracheostomy. Advances in creating algorithms calculation and distribution of more accurate dose enabled the development of dosimetry and quality control in radiotherapy,providing a more conservative approach. Th e radiotherapy with intensity modulation has high precision with better protection of organs at risk. Altered fractionation schemes can reduce the late toxicity with survival benefi t. Tomotherapy, volumetric modulated archoterapy, stereotactic radiotherapy and FDG-PET CT are recent approaches. Induction and sequential chemotherapy is a key component in the treatment of locally advanced head and neck cancer. Th e receiver of Epidermal Growth Factor IgG1 monoclonal antibody (EGFR) showed signifi cant clinical benefi ts in the treatment of locally advanced, recurrent and/or metastatic cancer. Conclusion: Th us, the treatment of head and neck cancer patients should be multidisciplinary and advances in strategies have improved the outcome.