University Hospital Hamburg Germany
In the last half century great progress in understanding the genetic and biochemical mechanisms underlying cancer has been achieved. Despite these advances cancer remains a major health problem with high mortality rates indicating that it is difficult to translate this knowledge into effective cancer treatments. Functional surgery like endoscopic laser treatment as well as open reconstructive surgery often fail to handle microscopic disease and are not able to reach dissiminated and distant disease.Chemotherapy even as radiotherapy target rapidly dividing cells.As a result normal tissues with high growth rates suffer and patients oft en experience adverse and sometimes deadly side effects. Over the last 15 years drugs have emerged that target cancer signal transduction and metabolism.Targeted therapy is typically less damaging to normal cells than chemotherapy. However cancer cells are extremely robust for survival .Drug resistance occurs when non targeted genes or proteins kick in to rescue the cancer cell by rerouting growth through alternative pathways.For this reason targeted therapy is most effective when used in combination with chemotherapy or radiotherapy. It is becoming appearent that in order to develop effective targeted therapies drug development will have to shift from singular molecular targets to pathways. Systems biology approaches will play a pivotal role in the development of drugs as well as in integrating surgery,chemotherapy, targeted therapy and radiotherapy into a holistic form of cancer treatment. Mathematical models and simulations(in silico experiments) can be performed to validate hypotheses and to make predictions about quantities that are difficult or impossible to measure in vivo. Th is lecture provide an actual overview of the essential variables in surgery,radiotherapy,chemotherapy and target therapy which influence the Quality of life,tumor free survival and overall survival of patients with Head and Neck Cancer. Th e lecture will give a forward look at the holistic way of treatment instead of the sequential and particularistic treatment even performed until today.