Head & Neck

Treatment Options

Your doctor will create a unique plan that focuses on achieving the goal you set together. That goal may be curative, or it may be to manage symptoms. Understanding the goal, as well as the benefits and risks of each option, will help you be more prepared to make shared treatment decisions with your doctor.

A personalized treatment plan is made up of many factors. Your doctor considers the stage or classification, type and location of your disease, and your age and your general health. Another important element is your vision of a desired quality of life, so talk with your doctor about how the suggested therapies may best fit in with your expectations.

As you consider treatment options, ask about palliative care, which focuses on providing physical and emotional relief for symptoms and side effects. It’s often mistaken for hospice care, but it actually accompanies your regular treatment. Starting it early in the treatment cycle has been shown in some cases to improve quality of life and extend survival rates.

Using one or more of these therapies, your doctor will also focus on preserving (as much as possible) your ability to speak, eat and breathe normally.

Surgery is the primary method for treating many solid tumors. Sometimes it is the only treatment needed for early-stage cancer. Many types of surgery are available to treat head and neck cancers, including those to stage the cancer or to relieve or prevent symptoms that might otherwise occur later. A neck dissection, which is the removal of lymph nodes and surrounding tissue from the neck, is a common procedure during head and neck cancer treatment. Surgery is often used in addition to other treatment types. Reconstructive Surgery may also be an option if appearance or functionality needs to be restored.

Drug therapy uses medications to destroy cancer cells, prevent progression or slow down their growth. The most widely used systemic therapies for head and neck cancer are chemotherapy, immunotherapy and targeted therapy (see Figure 1).

 

Chemotherapy is a systemic therapy (one that travels throughout the body) that may be given through a small tube inserted into a vein (IV) or taken orally as a pill. A specific strategy may consist of a single chemotherapy drug, a combination given at the same time, or one after another. It may be used alone or with other forms of treatment.

Immunotherapy trains the immune system to respond to cancer cells and has the potential for a more lasting response that extends beyond treatment. Immune checkpoint inhibitors are approved by the U.S. Food and Drug Administration for head and neck cancer and may be given intravenously (IV). They target the proteins PD-1 (programmed cell death protein 1) and PD-L1 (programmed cell death-ligand 1) found on cells of the immune system and cancer, respectively. Normally when these proteins interact, the immune system is shut down. The immune checkpoint inhibitors block this activity, thereby boosting the immune system’s cancer-fighting response (see Figure 2).

 

Targeted therapy uses drugs or other substances to identify and attack specific types of cancer cells to help slow or stop cancer growth. They may be given intravenously (IV). Many are oral medications, and some may be given in combination with other drug therapies. To treat certain head and neck cancers, these drugs target specific genes, such as BRAF, RET and NTRK, or proteins and growth factors, including VEGF, EGFR and MEK. It may be used with or without chemotherapy and after surgery for advanced stage head and neck cancers.

 

Some head and neck cancer drugs As of 3/2/21
bleomycin sulfate (Blenoxane)
cabozantinib (Cometriq)
cetuximab (Erbitux)
cisplatin (Platinol)
dabrafenib (Tafinlar) and trametinib (Mekinist)
docetaxel (Taxotere)
doxorubicin hydrochloride (Adriamycin)
entrectinib (Rozlytrek)
hydroxyurea (Hydrea)
larotrectinib (Vitrakvi)
lenvatinib (Lenvima)
methotrexate sodium (Methotrexate LPF)
nivolumab (Opdivo)
pembrolizumab (Keytruda)
pralsetinib (Gavreto)
selpercatinib (Retevmo)
sorafenib (Nexavar)
vandetanib (Caprelsa)

 

Radiation therapy is the use of high-energy particles, such as X-rays, to kill cancer cells and may be used alone or with other treatments. It is sometimes recommended when cancer has spread to the bones, and it is commonly used after surgery to kill any remaining cancer cells to lower the risk of recurrence. When it is used after surgery, it is called adjuvant therapy. Radiation therapy may also be used to manage pain.

Radiation therapy is delivered externally and internally. External-beam radiation therapy (EBRT) is delivered from a machine and is used to treat many types of cancer. Types of EBRT include proton therapy, 3-D conformal radiation therapy, intensity-modulated radiation therapy (IMRT), hyperfractionated therapy and stereotactic radiosurgery.

Brachytherapy is a type of internal radiation therapy in which radioactive material sealed in needles, seeds, wires or catheters is placed directly into or near a tumor.

 

Thermoplastic Mask: A Safety Measure During Radiation Therapy

For radiation therapy to be most effective, the radiation beams must target the same spot every time. In most cases, semi-permanent marks or permanent tattoos are placed on your skin to indicate the exact location the radiation beams must hit to reach the tumor. To ensure your safety, you must be in the same position for every treatment. Sometimes, body molds or other immobilizing devices may be necessary. A special mesh head mask, called a thermoplastic mask, may be created from a mold of your face and head. Wearing the mask and being unable to move can be upsetting, especially if you are claustrophobic. Your treatment team will help make you as comfortable as possible, so tell them if you feel anxious. If necessary, your doctor may prescribe medication to help you relax.

 

 

Chemoradiation combines chemotherapy with radiation therapy. It makes cancer cells more sensitive to radiation, making it easier for the radiation to kill them.

Radioactive iodine treatment involves giving radioactive iodine (I-131) in liquid or pill form to treat some forms of thyroid cancer. It may be used after surgery in patients with thyroid cancer who are at increased risk of recurrence. The radioactive iodine will concentrate in any remaining thyroid tissue, and the radiation will kill the cancer cells.

Clinical trials are medical research studies that may offer access to leading-edge therapies not yet widely available (see Clinical Trials).

 

The Role of Biomarkers in Diagnosis and Treatment

 

An ongoing challenge with diagnosing and treating head and neck cancer is detecting it early so the treatment can be most effective. Although some screening methods exist, doctors are studying ways to diagnose the cancer earlier and develop a more personalized treatment plan. In several cancers, this is often accomplished by testing for biomarkers.

Biomarkers are substances, such as genes or molecules, that can be measured in the blood, plasma, urine, cerebrospinal fluid or other body fluids or tissues. They are produced by cancer cells or other cells of the body in response to cancer. Biomarkers are also known as tumor markers or biological markers.

Biomarkers may be prognostic, predictive or diagnostic. A prognostic biomarker provides information about a person’s overall cancer outcome, regardless of therapy, while a predictive biomarker gives information about the effect of a specific treatment approach. Diagnostic biomarkers help determine the type of tumor. Some biomarkers may also help determine how aggressive (fast-growing) a tumor is and may predict long-term survival.

Doctors often test for the following:

  • Epstein-Barr virus (EBV) is associated with some nasopharyngeal cancers and may be tested to help diagnose it as well as assess the response of therapy and monitor for recurrence.
  • Genes may be tested to determine a patient’s eligibility to receive certain types of targeted therapy. Currently, therapies are approved for people with abnormalities in the BRAF, RET and NTRK genes.
  • Human papillomavirus (HPV) has strains that are linked to throat cancer, specifically oropharyngeal. HPV is primarily tested with throat cancers as a part of the staging process. Research is still determining if HPV is a biomarker for any of the other types of head and neck cancer.
  • Programmed cell death-ligand 1 (PD-L1) is used as a predictive biomarker to determine if a patient will respond to immunotherapy. At this time, it is the only biomarker to test for a response to immunotherapy.
  • Proteins and growth factors affect how tumor cells develop and survive. These are tested to determine if a person has abnormalities in the vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR) and the MEK protein. Some types of targeted therapy are available to treat these abnormalities with tyrosine kinase inhibitors (TKIs).
  • Smoking status is checked to determine the potential effectiveness of radiation therapy and surgical treatment because smoking is known to reduce it. It also is associated with an increased risk of second cancers.
  • Thyroid hormone levels, including thyroglobulin, thyroid-stimulating hormone and medullary type-specific tests, which include calcitonin and carcino-embryonic antigen levels, are biomarkers for thyroid cancer.

 

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