BUFFALO, NYTechniques developed over the past 20 years have
improved outcomes for patients with head and neck cancers. Speakers
at the Surgical Oncology Symposium sponsored by Roswell Park Cancer
Institute described new surgical methods that offer further
improvement in quality of life and new studies of preventive agents.
Prevention is possible in head and neck cancers. Leukoplakia, a
precancerous condition in the mouth, can be prevented by the use of
vitamin A, said Marshall Urist, MD, professor and director of
General Surgery, University of Alabama. Treatment with vitamin
A does not permanently stop leukoplakia. It will return when
treatment stops. But it points to a method of preventing precancerous
cells from turning into cancer in patients who are at high risk,
The use of 13-cis-retinoic acid (isotretinoin) at a dose of 1
mg/kg/day for 3 months, has been shown to prevent the development of
squamous cell carcinoma of the upper aerodigestive tract. This agent
is an isomer of retinoic acid, a metabolite of retinol (vitamin A).
A surrogate endpoint biomarker, tumor growth factor (TGF)-alpha, is
being used to track the effectiveness of 13-cis-retinoic acid
in current studies.
In patients who have completed vitamin A therapy, we found that
TGF-alpha levels dropped when leukoplakia was effectively
treated, Dr. Urist said. However, the vitamin A dose
offered has many side effects and cannot be maintained indefinitely.
When stopped, the leukoplakia returned, and TGF-alpha levels rose
A new trial is using the same 3-month treatment with a follow-up
maintenance dose of 0.25 mg/kg/day for 9 months. This is a
first step toward reversing cellular changes that lead to
cancer, he said.
For patients who do progress to head and neck cancer, new surgical
methods have improved treatment and overall survival, said J. Edward
Young, MD, head of surgical oncology, Hamilton Regional Cancer Center
and McMaster University, Hamilton, Ontario.
Recent advances in head and neck reconstruction after radical
cancer surgery offer patients excellent outcomes without the need for
multistage surgical reconstruction, Dr. Young said. This
advance has been made possible by free flap techniques
that allow the surgeon to transfer skin, muscle, and bone from remote
surgical sites and then reestablish the blood supply to this new
tissue in the head and neck with microscopic small vessel
This has had a tremendous impact on our ability to resect and
rehabilitate patients with advanced head and neck cancer, Dr.
One particular surgery that has benefited from free flap techniques
is the reconstruction of the mandible.
In particular, a major change in the past 20 years has
been the ability to reconstruct the anterior mandible with well-vascularized
bone from the leg, arm, ribs, or hip to provide excellent contour
and function. In some cases, this technique even allows for dental
implants, Dr. Young said.