Treatment Concepts

• Single-modality Therapy: treatment of early staged disease with primary surgery or radiation therapy alone

• Multimodality Therapy: combined therapeutic approaches for advanced disease

• Surgical Therapy: advantages include quicker extirpation of the tumor and provision of specimen for margin analysis; disadvantages include potential risk of anesthesia and functional disability; a tumor is considered unresectable if it involves the base of skull, nasopharynx, prevertebral fascia, floor of neck, mediastinum, or subdermal lymphatics (carotid artery involvement is a relative contraindication)

• Radiation Therapy: (see below) generally indicated as primary therapy for early glottic, hypopharyngeal, and nasopharyngeal cancers and as adjuvant therapy for advanced head and neck cancer; advantages include easier access for poorly exposed tumors and generally less functional disability; disadvantages include lengthy course treatment, less responsiveness to larger or deeper tumors, inability for second course radiation therapy for recurrence within previously irradiated fields, difficult to detect recurrent cancer, salvage surgery for radiation failure is associated with higher morbidity (conservation surgery may not be possible for recurrence)

• Chemotherapy: (see below) generally indicated for palliation for disseminated disease, recurrent or unresectable cancer, laryngeal preservation, esophageal and nasopharyngeal cancers, chemoprevention (retinoids), and clinical protocols

• Clinical Trial Designs: Phase I trials define the maximum tolerated dose of the treatment regimen; Phase II trials test the efficacy of the treatment of regimen on one or more tumor sites and toxicity; Phase III trials are randomized, prospective trials that evaluate the new treatment effect compared to the standard treatment

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