Head & Neck Cancer Treatment
Early stage lesions are highly curable by surgery alone, radiation therapy alone, or a combination. The choice of modality depends on the location of the tumor, the potential cosmetic defect, and the functional result of the treatment. The decision for treatment must be made on advice from the surgeon, radiation oncologist, and medical oncologist, as well as rehabilitation specialists. For more advanced cancers, treatment with surgery and post-operative radiation is appropriate, with or without neoadjuvant chemotherapy.
Treatment options are similar to those for oral cavity: concurrent chemoradiotherapy; organ preservation protocols.
Surgery (laryngopharyngectomy) followed by high dose radiation therapy to primary site and neck is the treatment of choice. Neoadjuvant chemotherapy (given prior to other modalities) is under clinical investigation.
For small superficial tumors, laser excision is an option, along with radiation or surgery. The key is to preserve vocal function, so radiation therapy is frequently attempted first, using surgery as a salvage procedure. More advanced laryngeal cancers can be treated with combination radiation and surgery.
Concurrent chemoradiation and organ preservation protocols.
Paranasal sinuses & nasal cavity
The treatment of choice is a combination of radiation and surgery. Sequence of treatment depends on the stage of the tumor at diagnosis.
Surgery is the preferred treatment for low-grade, low-stage tumors. Lymph node dissection should be included as part of the definitive treatment if nodes are involved. Radiation therapy may be added when lymph nodes are involved, or when the possible cosmetic result from surgery is unfavorable.
Surgery is the treatment of choice for localized lesions, followed by TSH-suppressing doses of exogenous thyroid hormone (thyroxine) to decrease the likelihood of recurrence. In some cases of advanced stage papillary and follicular cancers, external beam radiation is an option after surgery.
The table on the following page provides a summary of preferred treatment modalities by site.