The Head and Neck Cancer Patient: Perioperative Care and Assessment, An Issue of Oral and Maxillofacial Surgery Clinics of North America, Volume 30-4

164 Pages·2018·21.602 MB·English

by  Zvonimir Milas, Thomas Schellenberger

The Head and Neck
Cancer Patient: Neoplasm
Management
Editors
ZVONIMIR L. MILAS
THOMAS D. SHELLENBERGER
ORAL AND MAXILLOFACIAL SURGERY
CLINICS OF NORTH AMERICA
www.oralmaxsurgery.theclinics.com
Consulting Editor
RUI P. FERNANDES
February 2019 • Volume 31 • Number 1

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TheHeadandNeckCancerPatient:NeoplasmManagement
Contributors
CONSULTING EDITOR
RUIP.FERNANDES,MD,DMD,FACS,
FRCS(Ed)
ClinicalProfessorandChief,DivisionofHead
andNeckSurgery,DepartmentsofOraland
MaxillofacialSurgery,Neurosurgery,and
OrthopaedicSurgery&Rehabilitation,
UniversityofFloridaHealthScienceCenter,
UniversityofFloridaCollegeofMedicine,
Jacksonville,FL,USA
EDITORS
ZVONIMIRL.MILAS,MD,FACS THOMASD.SHELLENBERGER,DMD,MD,
AssociateProfessor,Director,HeadandNeck FACS
CancerCenter,DivisionofSurgicalOncology, HeadandNeckSurgicalOncologist,Divisionof
LevineCancerInstitute,AtriumHealthcare, SurgicalOncology,BannerMDAnderson
Charlotte,NorthCarolina,USA CancerCenter,Gilbert,Arizona,USA;Adjunct
AssistantProfessor,DepartmentofHeadand
NeckSurgery,TheUniversityofTexasMD
AndersonCancerCenter,Houston,Texas,USA
AUTHORS
PAYAMAFZALI,DDS,MD CURTISM.BRYANT,MD,MPH
DepartmentofOralandMaxillofacialSurgery, AssistantProfessor,Departmentof
UniversityofMichigan,AnnArbor,Michigan, RadiationOncology,UniversityofFlorida
USA CollegeofMedicine,Gainesville,Florida,
USA
JULIEE.BAUMAN,MD,MPH
Professor,Medicine,Chief,Divisionof
HematologyandOncology,AssociateDirector,
ERICR.CARLSON,DMD,MD,EdM,FACS
TranslationalResearch,TheUniversityof
ProfessorandKellyL.Krahwinkel
ArizonaCancerCenter,Tucson,Arizona,USA
Chairman,DepartmentofOraland
RICHARDBRYANBELL,MD,DDS,FACS MaxillofacialSurgery,DirectorofOraland
MedicalDirector,HeadandNeckSurgical MaxillofacialSurgeryResidencyProgram,
Oncologist,EarleA.ChilesResearchInstitute, DirectorofOral/HeadandNeckOncologic
RobertW.FranzCancerCenter,Providence SurgeryFellowshipProgram,The
PortlandMedicalCenter,ProvidenceCancer UniversityofTennesseeCancer
Institute,HeadandNeckInstitute,Portland, Institute,Knoxville,Tennessee,
Oregon,USA USA

Copyright ©2018. Elsevier Inc. All rights reserved.
iv Contributors
DANIELR.CARRIZOSA,MD,MS EDWARDS.KIM,MD,FACP
SectionLeader,HeadandNeckDivision, Chair,SolidTumorOncologyand
DepartmentofSolidTumorOncology,Levine InvestigationalTherapeutics,DonaldS.Kim
CancerInstitute,Charlotte,NorthCarolina,USA DistinguishedChairforCancerResearch,
LevineCancerInstitute,Charlotte,North
ROIDAGAN,MD
Carolina,USA
AssistantProfessor,DepartmentofRadiation
Oncology,UniversityofFloridaCollegeof ROMLEIDNER,MD
Medicine,Gainesville,Florida,USA MedicalOncologist,EarleA.ChilesResearch
Institute,RobertW.FranzCancerCenter,
KYLES.ETTINGER,MD,DDS
ProvidencePortlandMedicalCenter,
MayoClinicScholar,DivisionofOral
ProvidenceCancerInstitute,Portland,Oregon,
andMaxillofacialSurgery,Departmentof
USA
Surgery,SectionofHeadandNeck
OncologicSurgeryandReconstruction, ILYALIKHTEROV,MD
MayoClinic,MayoCollegeofMedicine, Thyroid,HeadandNeckCancerFoundation,
Rochester,Minnesota,USA;HeadandNeck DepartmentofOtolaryngologyHeadandNeck
OncologicSurgeryandMicrovascular Surgery,MountSinaiBethIsrael,Department
ReconstructionFellow,Departmentof ofOtolaryngologyHeadandNeckSurgery,
OralandMaxillofacialSurgery,Divisionof IcahnSchoolofMedicineatMountSinai,New
HeadandNeckSurgery,Universityof York,NewYork,USA
FloridaCollegeofMedicine,Jacksonville,
Florida,USA WILLIAMM.MENDENHALL,MD
Professor,DepartmentofRadiationOncology,
ZACHARYL.FARMER,MD
UniversityofFloridaCollegeofMedicine,
Fellow,LevineCancerInstitute,Charlotte,
Gainesville,Florida,USA
NorthCarolina,USA
ANDREWT.MERAM,DDS,MD
RUIP.FERNANDES,MD,DMD,FACS,
AssistantProfessor,DepartmentofOraland
FRCS(Ed)
MaxillofacialSurgery/HeadandNeckSurgery,
ClinicalProfessorandChief,DivisionofHead
LouisianaStateUniversityHealthScience
andNeckSurgery,DepartmentsofOraland
Center,Shreveport,Louisiana,USA
MaxillofacialSurgery,Neurosurgery,and
OrthopaedicSurgery&Rehabilitation, RANDAOBID,BA
UniversityofFloridaHealthScienceCenter, Student,MDProgram,GeorgeWashington
UniversityofFloridaCollegeofMedicine, SchoolofMedicineandHealthSciences,
Jacksonville,FL,USA Washington,DC,USA
LAURENTGANRY,MD
STAVANY.PATEL,DDS,MD
HeadandNeckOncologicSurgeryand
HeadandNeckOncologyandMicrovascular
MicrovascularReconstructionFellow,
ReconstructiveSurgeryFellow,Departmentof
DepartmentofOralandMaxillofacialSurgery,
OralandMaxillofacialSurgery/Headand
DivisionofHeadandNeckSurgery,University
NeckSurgery,LouisianaStateUniversity
ofFloridaCollegeofMedicine,Jacksonville,
HealthScienceCenter,Shreveport,Louisiana,
Florida,USA;DepartmentofMaxillo-facial,
USA
Plastic,ReconstructiveandAestheticSurgery,
HenriMondorHospital,Cre´teil,France MAGIREDLICH,BSN
NurseNavigator,CaseManagement,BannerMD
DONGSOOD.KIM,DMD,MD,FACS
AndersonCancerCenter,Gilbert,Arizona,USA
ProfessorandChief,DivisionofHeadandNeck
Oncology,MicrovascularReconstructive ANSLEYM.ROCHE,MD
Surgery,DepartmentofOralandMaxillofacial DepartmentofOtolaryngologyHeadandNeck
Surgery/HeadandNeckSurgery, Surgery,DonaldandBarbaraZuckerSchoolof
LouisianaStateUniversityHealth MedicineatHofstra/Northwell,Northwell
ScienceCenter,Shreveport,Louisiana,USA Health,StatenIsland,NewYork,USA

Copyright ©2018. Elsevier Inc. All rights reserved.
Contributors v
THOMASSCHLIEVE,DDS,MD CHAFEEKTOMEH,MD,MPH,FACS
AssistantProfessor,DirectorofOraland HeadandNeckSurgicalOncologist,
MaxillofacialSurgeryResidencyProgram, DivisionofSurgicalOncology,BannerMD
DivisionofOralandMaxillofacialSurgery,The AndersonCancerCenter,Gilbert,Arizona,
UniversityofTexasSouthwesternMedical USA
School,ParklandMemorialHospital,Dallas,
Texas,USA MARKL.URKEN,MD
Thyroid,HeadandNeckCancer
FELIXSIM,MBBS,BDS,FRACDS(OMS)
Foundation,DepartmentofOtolaryngology
DepartmentofOralandMaxillofacialSurgery,
HeadandNeckSurgery,MountSinai
TheRoyalMelbourneHospital,Parkville,Victoria,
BethIsrael,DepartmentofOtolaryngology
Australia;DepartmentofOralandMaxillofacial
HeadandNeckSurgery,IcahnSchoolof
Surgery,MonashHealth,BentleighEast,
MedicineatMountSinai,NewYork,NewYork,
Victoria,Australia;OralandMaxillofacialSurgery
USA
Unit,BarwonHealth,Geelong,Victoria,Australia
SIMRANK.SINDHU,DO BRENTBENSONWARD,DDS,MD
AssistantProfessor,Medicine,TheUniversity DepartmentofOralandMaxillofacialSurgery,
ofArizonaCancerCenter,Tucson,Arizona, UniversityofMichigan,AnnArbor,Michigan,
USA USA

Copyright ©2018. Elsevier Inc. All rights reserved.
TheHeadandNeckCancerPatient:NeoplasmManagement
Contents
Preface: The HeadandNeck CancerPatient: Neoplasm Management xi
ZvonimirL.MilasandThomasD.Shellenberger
TheTreatmentof Laryngeal Cancer 1
RandaObid,MagiRedlich,andChafeekTomeh
Successfulmanagementoflaryngealcancerdependsoncarefulpretreatmenteval-
uationofpatientanddiseasefactorstoarriveataccuratestaging,leadingtoappro-
priate treatment selection for patients with this highly impacting disease. Surgical
modalities, including transoral laser microsurgery, open partial laryngectomy, and
totallaryngectomy,offeroptions,aloneorincombinationwithradiationandchemo-
therapy.Treatmentstrategyforlaryngealcancershouldstriveforcurewhilemain-
taining thebest quality of life possiblefor the patient. Achieving the goals ofinitial
and salvage treatment for laryngeal cancer depends on executing a plan of care
determinedbytheexpertiseofthemultidisciplinaryteam.
OralCavityCancer 13
KyleS.Ettinger,LaurentGanry,andRuiP.Fernandes
Management of oral cavity squamous cell carcinoma has become increasingly
drivenbyemergingevidenceasaresultoftheimprovedqualityofclinicalresearch
associating clinicopathologic risk factors with oncologic and survival outcomes.
Multiple significant recent changes to treatment guidelines and staging algorithms
for oral cavity squamous cell carcinoma reflect evolving understanding of tumor
biology and the need for adequately extensive treatment of aggressive disease.
Thisarticleprovidesclinicianswithasynopsisofthemostcontemporarymanage-
mentstrategiesfororalcavitysquamouscellcarcinoma,framedwithinthecontext
ofhistoricaltreatmentphilosophies.
Radiation Oncologyfor Headand NeckCancer: CurrentStandardsand Future
Changes 31
WilliamM.Mendenhall,RoiDagan,CurtisM.Bryant,andRuiP.Fernandes
Treatmentofheadandneckcancerwithcurativeintentconsistsofsurgeryand/or
radiotherapy (RT) sometimes combined with adjuvant chemotherapy depending
on the tumor site, extent, and histology. Herein, the authors review the role of RT
in the management of head and neck mucosal squamous cell carcinoma (SCC).
TheauthorsfocusontheoutcomesofdefinitiveRTand,dependingontheprimary
site,postoperativeRT.Unlessotherwisespecified,outcomesdatacitedarefromthe
UniversityofFlorida.
SoftTissueReconstruction for Headand NeckAblative Defects 39
StavanY.Patel,AndrewT.Meram,andDongsooD.Kim
Softtissuereconstructionofheadandneckablativedefectsisabroad,challenging,
andsubjectivetopic.Theauthorsoutlinegoalstokeepinmindwhendecidingona
primary reconstructive option for defects created by oncologic resection. Factors
considered in local, regional, and distant flap selection are discussed. Based on
the goals of reconstruction and factors involved in flap selection, a defect-based

Copyright ©2018. Elsevier Inc. All rights reserved.
Contents
viii
reconstructive algorithm is developed to help choose the ideal reconstructive op-
tion.Theauthorsalsodiscussindications,pearls,pitfalls,andchallengesinthehar-
vestandinsetofcommonlyusedsofttissueflapsforheadandneckreconstructive
surgery.
Managementof theNeck inOralSquamous CellCarcinoma: Background,
Classification, and CurrentPhilosophy 69
PayamAfzaliandBrentBensonWard
Nodal metastasis is the single most prognostic determinant in patients with oral
squamouscellcarcinoma (OSCC). Nodal metastasisisthesingle most prognostic
determinantinpatientswithOSCC.Thedecisionfortheextentoftheneckdissec-
tion is tailored to tumor-specific characteristics, which dictate the probability and
extent of nodal metastasis, including tumor size, location, histopathologic charac-
teristics, and the presence orabsence ofclinical nodal disease. These factors are
toolstoaiddiagnosticiansintheirdecisionmakingforindividualpatients.
Immunotherapy forHeadand Neck Cancer 85
FelixSim,RomLeidner,andRichardBryanBell
Theimmunesystemhasavitalroleinthedevelopment,establishment,andprogres-
sionofheadandnecksquamouscellcarcinoma(HNSCC).Immuneevasionofcan-
cer cells leads to progression of HNSCC. An understanding of this mechanism
providesthebasisforimprovedtherapiesandoutcomesforpatients.Throughthe
tumor’s influence on the microenvironment, the immune system can be exploited
topromotemetastasis,angiogenesis,andgrowth.Thisarticleprovidesanoverview
oftheinteractionbetweenimmuneinfiltratingcellsinthetumormicroenvironment,
andtheimmunologicprinciplesrelatedtoHNSCC.Currentimmunotherapeuticstra-
tegiesandemergingresultsfromongoingclinicaltrialsarepresented.
ContemporaryOsseousReconstruction of theMandible andtheMaxilla 101
IlyaLikhterov,AnsleyM.Roche,andMarkL.Urken
Cancersoftheoralcavityandparanasalsinusesoftenrequireablativesurgerywith
adjuvanttherapyinmostcases.Large,postablativedefectsofthemandibleandthe
maxilla present several challenges to the reconstructive surgeon. Functional and
cosmetically satisfactory restoration requires a thorough understanding of the un-
derlyingdisease process,a firm graspofthe nuancesofhead and neckanatomy,
and an ability to plan and execute a reconstruction with the most suitable tissue
foreachparticularpatient.Theauthorsoutlinethecomponentsofosseousrecon-
structionofthefacialskeletonwithabiastowardtechniquesandapproachesthat
areparticularlyuseful.
GeneTherapyinHead andNeck Cancer 117
ZacharyL.Farmer,EdwardS.Kim,andDanielR.Carrizosa
Althoughoverallcancer deathrates are decreasing,comparative improvementsin
headandnecksquamouscellcanceraremodest.Althoughnewadvancestargeting
immunecheckpointsmaysoonimprovethesenumbers,additionalresearchfornew
therapeuticoptionsisvital.Onepotentialtreatmentavenueistheuseofgenether-
apy. This article provides insight into some gene therapy targets and varied tech-
niques being evaluated for patients with head and neck cancer. Techniques

Copyright ©2018. Elsevier Inc. All rights reserved.
Contents ix
include corrective gene therapy, cytoreductive gene therapy, and gene editing, in
additiontoadiscussionongenetherapyvectors.
SalivaryGlandMalignancies 125
EricR.CarlsonandThomasSchlieve
Salivaryglandtumorsarerarepathologicentitiesthatarederivedfrommajorandmi-
norsalivaryglandtissuelocatedthroughouttheheadandneckregion.Thesetumors
are distinctly heterogenous, comprising numerous cell types, especially those
deemed malignant. The incidence of malignant salivary gland tumors is widely
distributedinbothadultandpediatricpatientpopulations.Accuratediagnosisand
optimaltreatmentofthesetumorsposechallengestobothinterpretingpathologists
andablativesurgeons.Thisarticleexaminestheepidemiologyandpathologyofma-
lignant tumors of the major and minor salivary glands and provides recommenda-
tionsforthemostsuccessfultreatmentapproaches.
Current Concepts inChemotherapy for HeadandNeck Cancer 145
SimranK.SindhuandJulieE.Bauman
This article highlights the evidence-based data to support systemic treatment op-
tionsforpatientswithheadandnecksquamouscellcarcinoma(HNSCC).Thedis-
coveryofthehumanpapillomavirusepidemicinHNSCCanditsfavorableprognosis
hasledtoamajorfocusofresearch.Patientsarestratifiedintoclinicalorpathologic
riskcategoriesandenrolledintrialscomparingstandardtreatmentparadigmswith
deintensification, in low-risk disease, or to intensification, in intermediate-risk or
high-risk disease. Immunotherapy has proven beneficial in second-line palliative
therapyandisunderinvestigationinfirst-linepalliativetherapyandasacomponent
ofdefinitive,multimodalitytherapyforhigh-riskpatients.

Copyright ©2018. Elsevier Inc. All rights reserved.
x TheHeadandNeckCancerPatient:NeoplasmManagement
ORAL AND MAXILLOFACIAL SURGERY
CLINICS OF NORTH AMERICA
FORTHCOMINGISSUES RECENTISSUES
May2019 November 2018
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OleT.Jensen,Editor Perioperative Care and Assessment
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Dental Implants, Part II: Computer Editors
Technology August 2018
OleT.Jensen,Editor Current Controversies in the Management
ofTemporomandibular Disorders
November 2019
DanielM.Laskinand
Advances in Oral and Maxillofacial Surgery
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