Less invasive surgeries; reconstructive breakthroughs
Radical neck dissections have been replaced in many cases by less radical surgeries that preserve nerves, arteries, and muscles in the neck. Patients continue to move, speak, breathe and eat normally after surgery. Patients with certain throat cancers, who a few years ago would have lost their vocal cords and their voices, can often be treated with a supraglottic laryngectomy, a less invasive surgery that preserves critical structures. Patients who undergo this surgery maintain their ability to speak, although they need to learn new ways to swallow. At Yale, rehabilitative specialists work with patients to help them adjust to and overcome some of these impairments.
One of the most exciting new surgical advances is the use of laser surgery to remove certain throat cancers using an endoscopic probe in the mouth. This technique allows surgeons to remove tumors without an open incision in the neck.
Breakthroughs in reconstructive surgery represent one of the biggest success stories for head and neck cancer patients. Reconstructive surgery has improved dramatically, yielding previously unattainable cosmetic and functional outcomes. Research data indicate that the results of complex surgical procedures like these reconstructions are best accomplished by specialists who perform them on a regular basis.
Radiation is critical for cure of almost all advanced head and neck cancers. Radiation therapy can be delivered alone or combined with chemotherapy as a primary therapy or after surgical therapy. New radiation techniques that precisely aim beams to target tumors are very important for patients with head and neck tumors since crucial structures are often very close to the tumors. Intensity modulated radiation therapy (IMRT) effectively targets the tumor while simultaneously minimizing damage to normal tissues.
Clinical trials are currently testing whether the overall dose of radiation can be reduced in certain patients who are extremely treatment responsive. Novel agents to sensitize cancer cells to radiation and to maintain treatment responses are also under study.
The integration of chemotherapy with radiation has become very important for patients with head and neck cancer that involves the lymph nodes or is locally extensive, and this approach can lead to organ preservation and increase the chance of cure for many patients. Breakthroughs in targeted therapy and biomarkers allow a personalized approach that can avoid the toxicities of conventional chemotherapy in some cases, and new treatments to prevent recurrence in high-risk situations are also under study. For patients with recurrent disease, new anti-cancer drugs and immunotherapies are also available.
Led by Dr. Barbara Burtness, the medical oncology team at Smilow Cancer Hospital continues to study innovative new treatments, and our patients have the opportunity to receive such novel therapies through exciting clinical trials only available at our Hospital.